Provider Demographics
NPI:1770505844
Name:EISNER, MARTIN ELI (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:ELI
Last Name:EISNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 62316
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-6077
Mailing Address - Country:US
Mailing Address - Phone:714-731-7871
Mailing Address - Fax:714-731-7872
Practice Address - Street 1:999 N TUSTIN AVE STE 109
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6504
Practice Address - Country:US
Practice Address - Phone:714-756-4820
Practice Address - Fax:714-953-3425
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG43023208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G430230Medicaid
CAAE9636690OtherDEA
CAG43023Medicare ID - Type Unspecified
CAA49199Medicare UPIN