Provider Demographics
NPI:1720125990
Name:MARTIN, ROBERT LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEE
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7750 UNIVERSITY AVE
Mailing Address - Street 2:STE C
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-4948
Mailing Address - Country:US
Mailing Address - Phone:619-697-9339
Mailing Address - Fax:
Practice Address - Street 1:7750 UNIVERSITY AVE
Practice Address - Street 2:STE C
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-4948
Practice Address - Country:US
Practice Address - Phone:619-697-9339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 296237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0002960Medicaid
CAWAU296AMedicare ID - Type UnspecifiedMEDICARE NUMBER