Provider Demographics
NPI:1255122115
Name:MARTIN, ANGEL ROGER (EMT)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:ROGER
Last Name:MARTIN
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:979 N ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-3980
Mailing Address - Country:US
Mailing Address - Phone:909-531-3246
Mailing Address - Fax:
Practice Address - Street 1:979 N ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-3980
Practice Address - Country:US
Practice Address - Phone:909-531-3246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE160074146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic