Provider Demographics
NPI:1679764450
Name:MARTINEZ, JONATHAN P (DO)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:P
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 E PALMDALE BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-4933
Mailing Address - Country:US
Mailing Address - Phone:661-947-5600
Mailing Address - Fax:661-947-5900
Practice Address - Street 1:2270 E PALMDALE BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4933
Practice Address - Country:US
Practice Address - Phone:661-947-5600
Practice Address - Fax:661-947-5900
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9822208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH73211Medicare UPIN
IL203246Medicare PIN