Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A74529 | CA |
N | 207QS0010X | Family Doctor - Sports Medicine | A74529 | CA |
NPI | 1003844507 |
---|---|
Provider Name | Dr. John Michael Martinez |
First Address | Rancho Cordova, CA 95670-7956 |
Second Address | Woodland, CA 95776-5423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 20/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G68093 | (02) |