Provider Demographics
NPI:1851455216
Name:MARTINEZ, THOMAS DELAO SR (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DELAO
Last Name:MARTINEZ
Suffix:SR
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 1:340 4TH AVE
Mailing Address - Street 2:#18
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3813
Mailing Address - Country:US
Mailing Address - Phone:619-420-1378
Mailing Address - Fax:619-420-1331
Practice Address - Street 1:340 4TH AVE
Practice Address - Street 2:#18
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3813
Practice Address - Country:US
Practice Address - Phone:619-420-1378
Practice Address - Fax:619-420-1331
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A319890Medicaid
CAA3199890Medicare ID - Type Unspecified
CA00A319890Medicaid