Provider Demographics
NPI:1649459611
Name:SAINT MARTIN, MANUEL LEONARDO (MD)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:LEONARDO
Last Name:SAINT 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:PO BOX 882228
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90009
Mailing Address - Country:US
Mailing Address - Phone:310-641-7311
Mailing Address - Fax:
Practice Address - Street 1:6033 W CENTURY BLVD
Practice Address - Street 2:SUITE 1107
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045
Practice Address - Country:US
Practice Address - Phone:310-641-7311
Practice Address - Fax:310-641-2501
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY51674812084P0800X
OK209332084P0800X
CAG516852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry