Provider Demographics
NPI:1023351889
Name:MARTIN, CHRISTINA SOUTHER (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:SOUTHER
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:SOUTHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 16162
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209
Mailing Address - Country:US
Mailing Address - Phone:310-526-0290
Mailing Address - Fax:310-526-0290
Practice Address - Street 1:1300 N VERMONT AVE
Practice Address - Street 2:#704
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027
Practice Address - Country:US
Practice Address - Phone:310-526-0290
Practice Address - Fax:310-526-0290
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-30
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI19658208600000X
390200000X
CAA156794208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program