Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC 24743 | CA |
N | 111NN1001X | Nutrition | DC 24743 | CA |
NPI | 1043491723 |
---|---|
Provider Name | Dr. Dina Marie Martin |
First Address | Mission Viejo, CA 92691-6316 |
Second Address | Mission Viejo, CA 92691-6316 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2007 |
Last Update Date | 10/10/2008 |