Provider Demographics
NPI:1356344170
Name:GARCIA, MARTIN ANDREW (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:ANDREW
Last Name:GARCIA
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 1:5451 LA PALMA AVE
Mailing Address - Street 2:STE 32
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1731
Mailing Address - Country:US
Mailing Address - Phone:714-228-1919
Mailing Address - Fax:
Practice Address - Street 1:5451 LA PALMA AVE
Practice Address - Street 2:STE 32
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1731
Practice Address - Country:US
Practice Address - Phone:714-228-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:2006-04-28
Deactivation Code:
Reactivation Date:2006-08-29
Provider Licenses
StateLicense IDTaxonomies
CAC35253207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC35253OtherSTATE LICENSE
CAC35253OtherSTATE LICENSE