Provider Demographics
NPI:1851689327
Name:WRESCH, MARTIN DAVID (RRT)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:DAVID
Last Name:WRESCH
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11201 BENTON ST
Mailing Address - Street 2:MAIL CODE 111P
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:72357
Mailing Address - Country:US
Mailing Address - Phone:909-825-7084
Mailing Address - Fax:909-777-3214
Practice Address - Street 1:11201 BENTON ST
Practice Address - Street 2:MAIL CODE 111P
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92357-1000
Practice Address - Country:US
Practice Address - Phone:909-825-7084
Practice Address - Fax:909-777-3214
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA00002536227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered