Provider Demographics
NPI:1710013974
Name:MARTINEZ, LANCE ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:ERIC
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 1:74 SPRUCE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1570
Mailing Address - Country:US
Mailing Address - Phone:415-453-8883
Mailing Address - Fax:
Practice Address - Street 1:74 SPRUCE RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:CA
Practice Address - Zip Code:94930-1570
Practice Address - Country:US
Practice Address - Phone:415-453-8883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66638208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics