Provider Demographics
NPI:1003570151
Name:MARTIN, JAMES SOTTO II (IDC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:SOTTO
Last Name:MARTIN
Suffix:II
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 SAN ANTONIO LN
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4776
Mailing Address - Country:US
Mailing Address - Phone:619-919-2640
Mailing Address - Fax:
Practice Address - Street 1:BLDG. 6905 HARRIS AVE
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:808-257-3365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
1088830020OtherDOD ID NUMBER