Provider Demographics
NPI:1609806942
Name:MARTINEZ, MARC DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:DAVID
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 662046
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-2046
Mailing Address - Country:US
Mailing Address - Phone:626-447-0296
Mailing Address - Fax:626-447-6057
Practice Address - Street 1:1701 SANTA ANITA AVE
Practice Address - Street 2:
Practice Address - City:SOUTH EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-3411
Practice Address - Country:US
Practice Address - Phone:626-350-7957
Practice Address - Fax:626-448-0485
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2008-06-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG45064207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G450640Medicaid
CAWG45064Medicare PIN
CAWG45064PMedicare PIN
CAWG45064OMedicare PIN
CAA49870Medicare UPIN