Provider Demographics
NPI:1629651872
Name:MARTIN, GABRIEL ELIJAH (MD)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:ELIJAH
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11234 ANDERSON ST RM A560
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2804
Mailing Address - Country:US
Mailing Address - Phone:909-558-4196
Mailing Address - Fax:909-558-4806
Practice Address - Street 1:11234 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2804
Practice Address - Country:US
Practice Address - Phone:909-558-4196
Practice Address - Fax:909-558-4806
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2023-03-16
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Provider Licenses
StateLicense IDTaxonomies
CAPTL10212208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology