Provider Demographics
NPI:1134447089
Name:MARCO A. MARTINEZ, M.D. INC
Entity type:Organization
Organization Name:MARCO A. MARTINEZ, M.D. INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-771-7466
Mailing Address - Street 1:4566 FLORENCE AVE
Mailing Address - Street 2:SUITE # 5
Mailing Address - City:CUDAHY
Mailing Address - State:CA
Mailing Address - Zip Code:90201-4345
Mailing Address - Country:US
Mailing Address - Phone:323-771-7466
Mailing Address - Fax:323-771-4920
Practice Address - Street 1:4566 FLORENCE AVE
Practice Address - Street 2:SUITE #5
Practice Address - City:CUDAHY
Practice Address - State:CA
Practice Address - Zip Code:90201-4345
Practice Address - Country:US
Practice Address - Phone:323-771-7466
Practice Address - Fax:323-771-4920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54076207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A540761Medicaid
CAA54076Medicare PIN