Provider Demographics
NPI:1679559769
Name:MARTINEZ, JOSEPH GERARD S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:GERARD S
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19601 MARINER AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-1671
Mailing Address - Country:US
Mailing Address - Phone:310-371-0813
Mailing Address - Fax:310-793-5480
Practice Address - Street 1:19601 MARINER AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-1647
Practice Address - Country:US
Practice Address - Phone:310-371-0813
Practice Address - Fax:310-793-5480
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78782208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA78782AMedicare UPIN
CAH62984Medicare UPIN