Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 038012319 | IL |
Y | 111NI0013X | Independent Medical Examiner | 33346 | CA |
NPI | 1790020097 |
---|---|
Provider Name | Dr. Dustin Martinez |
First Address | Los Angeles, CA 90025-5363 |
Second Address | Los Angeles, CA 90025-5363 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2012 |
Last Update Date | 16/02/2016 |