Provider Demographics
NPI:1891877056
Name:MARTINEZ, EUFROCINO CABOTAJE (M D)
Entity Type:Individual
Prefix:DR
First Name:EUFROCINO
Middle Name:CABOTAJE
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 W 236TH PL
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-5954
Mailing Address - Country:US
Mailing Address - Phone:310-539-9584
Mailing Address - Fax:310-539-2713
Practice Address - Street 1:12820 STUDEBAKER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-2578
Practice Address - Country:US
Practice Address - Phone:562-651-0021
Practice Address - Fax:562-651-1122
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35980208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA35980OtherMEDICAL LICENSE
CAC35452Medicare UPIN