Provider Demographics
NPI:1619620721
Name:MARTIS, ALEXANDER PHILIP (LVN)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:PHILIP
Last Name:MARTIS
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 B AVE APT 320
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-3367
Mailing Address - Country:US
Mailing Address - Phone:442-236-0246
Mailing Address - Fax:
Practice Address - Street 1:8875 AERO DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2251
Practice Address - Country:US
Practice Address - Phone:800-698-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA687987164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA687987OtherLVN