Provider Demographics
NPI:1780896142
Name:JENSEN, MARTIN THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:THOMAS
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:30110 CROWN VALLEY PKWY STE 108
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2043
Mailing Address - Country:US
Mailing Address - Phone:949-363-2600
Mailing Address - Fax:949-363-2605
Practice Address - Street 1:30110 CROWN VALLEY PKWY STE 108
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2043
Practice Address - Country:US
Practice Address - Phone:949-363-2600
Practice Address - Fax:949-363-2605
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG557732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry