Provider Demographics
NPI:1811573975
Name:SAN MARTIN, JERRY
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:SAN MARTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13002 SHREVE RD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-3567
Mailing Address - Country:US
Mailing Address - Phone:626-378-0348
Mailing Address - Fax:
Practice Address - Street 1:1300 S. GRAND AVE.
Practice Address - Street 2:BLDG C, STE 213
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705
Practice Address - Country:US
Practice Address - Phone:714-567-7628
Practice Address - Fax:714-567-7633
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator