Provider Demographics
NPI:1871688200
Name:MARTIN, TAMELA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMELA
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TAMELA
Other - Middle Name:ANN
Other - Last Name:MONTELEONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:72301 COUNTRY CLUB DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-8007
Mailing Address - Country:US
Mailing Address - Phone:760-568-3334
Mailing Address - Fax:760-568-3335
Practice Address - Street 1:72301 COUNTRY CLUB DR
Practice Address - Street 2:SUITE 105
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-8007
Practice Address - Country:US
Practice Address - Phone:760-568-3334
Practice Address - Fax:760-568-3335
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77469207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G47349Medicare UPIN
CACH051AMedicare PIN