Provider Demographics
NPI:1972667178
Name:MARTIN, PAUL (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 SOLAR DR
Mailing Address - Street 2:SUITE 261
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-0134
Mailing Address - Country:US
Mailing Address - Phone:805-660-0507
Mailing Address - Fax:
Practice Address - Street 1:1701 SOLAR DR
Practice Address - Street 2:SUITE 261
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-0134
Practice Address - Country:US
Practice Address - Phone:805-660-0507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15556103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP15556BMedicare PIN
CAP36890Medicare UPIN