Provider Demographics
NPI:1790952729
Name:MARTIN, ZARREH (L AC)
Entity Type:Individual
Prefix:
First Name:ZARREH
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 S LOUISE ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1637
Mailing Address - Country:US
Mailing Address - Phone:818-636-6840
Mailing Address - Fax:
Practice Address - Street 1:208 S LOUISE ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1637
Practice Address - Country:US
Practice Address - Phone:626-229-9055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11954171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist