Provider Demographics
NPI:1770615544
Name:MARTIN, ANTONIO HARVEY
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:HARVEY
Last Name:MARTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 ALAMEDA ST # 3
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-2440
Mailing Address - Country:US
Mailing Address - Phone:626-463-8776
Mailing Address - Fax:
Practice Address - Street 1:865 ALAMEDA ST # 3
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-2440
Practice Address - Country:US
Practice Address - Phone:626-463-8776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator