Provider Demographics
NPI:1295921229
Name:MARTIN, TERRIN E (MD)
Entity type:Individual
Prefix:DR
First Name:TERRIN
Middle Name:E
Last Name:MARTIN
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 1:1411 N DETROIT ST
Mailing Address - Street 2:UNIT 103
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-4488
Mailing Address - Country:US
Mailing Address - Phone:310-482-8550
Mailing Address - Fax:
Practice Address - Street 1:1411 N DETROIT ST
Practice Address - Street 2:UNIT 103
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-4488
Practice Address - Country:US
Practice Address - Phone:310-482-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99078207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABH358UMedicare PIN
CABH358ZMedicare PIN
CABH358XMedicare PIN