Provider Demographics
NPI:1184692923
Name:MARTIN-REAY, DAVID G (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:MARTIN-REAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9301 OAKDALE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-6595
Mailing Address - Country:US
Mailing Address - Phone:818-718-9500
Mailing Address - Fax:818-718-9507
Practice Address - Street 1:PUEBLO AT BATH STREET
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105
Practice Address - Country:US
Practice Address - Phone:805-569-7367
Practice Address - Fax:805-569-8354
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8817207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806618300Medicaid
ID000010143418OtherREGENCE BLUE SHIELD ID
CA1184692923Medicaid
ID54577OtherBLUE CROSS OF ID
ID806618300Medicaid
ID000010143418OtherREGENCE BLUE SHIELD ID
ID54577OtherBLUE CROSS OF ID