Provider Demographics
NPI:1255537957
Name:KENNETH P MARTINEZ MD A MEDICAL CORP
Entity type:Organization
Organization Name:KENNETH P MARTINEZ MD A MEDICAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NEUROLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-305-7122
Mailing Address - Street 1:5 JOURNEY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5336
Mailing Address - Country:US
Mailing Address - Phone:949-305-7122
Mailing Address - Fax:949-305-7160
Practice Address - Street 1:5 JOURNEY STE 210
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-5332
Practice Address - Country:US
Practice Address - Phone:949-305-7122
Practice Address - Fax:949-305-7160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA66709OtherCA LICENSE
CAH49042Medicare UPIN