Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | A258660 | CA |
NPI | 1023014800 |
---|---|
Provider Name | Dr. Ivan P Martinez |
First Address | Anaheim Hills, CA 92807-4759 |
Second Address | Anaheim Hills, CA 92807-4759 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2005 |
Last Update Date | 01/09/2010 |