Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1275073470 |
---|---|
Provider Name | Dr. Paul Martinus |
First Address | Lockwood, CA 93932-0247 |
Second Address | Lockwood, CA 93932 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2017 |
Last Update Date | 20/05/2021 |