Provider Demographics
NPI:1710093083
Name:MARTINEZ, CARLOS ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ENRIQUE
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 1:3325 PALO VERDE AVENUE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-4132
Mailing Address - Country:US
Mailing Address - Phone:562-421-2757
Mailing Address - Fax:562-420-7267
Practice Address - Street 1:3325 PALO VERDE AVENUE
Practice Address - Street 2:SUITE 103
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-4132
Practice Address - Country:US
Practice Address - Phone:562-421-2757
Practice Address - Fax:562-420-7267
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68745207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A687450Medicaid
G91829Medicare UPIN
WA68745AMedicare ID - Type Unspecified