Provider Demographics
NPI:1801800750
Name:HYNES, MARTHA S (MD)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:S
Last Name:HYNES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20911 EARL ST STE 460
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4355
Mailing Address - Country:US
Mailing Address - Phone:310-540-4060
Mailing Address - Fax:310-316-3761
Practice Address - Street 1:20911 EARL ST STE 460
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4355
Practice Address - Country:US
Practice Address - Phone:310-540-4060
Practice Address - Fax:310-316-3761
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47713207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92750Medicare UPIN
CAWG47713AMedicare ID - Type Unspecified