Provider Demographics
NPI:1770519621
Name:LOUIE, MARTIN D (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:D
Last Name:LOUIE
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 501132
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92150-1132
Mailing Address - Country:US
Mailing Address - Phone:949-855-2843
Mailing Address - Fax:
Practice Address - Street 1:22941 TRITON WAY
Practice Address - Street 2:SUITE 148
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1238
Practice Address - Country:US
Practice Address - Phone:949-855-2843
Practice Address - Fax:949-581-9686
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41284207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A412843Medicaid
CA00A412840Medicare ID - Type Unspecified
CA00A412843Medicaid