Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1033440094 |
---|---|
Provider Name | Eduardo Fabian Martinez |
First Address | Long Beach, CA 90807-4628 |
Second Address | Long Beach, CA 90807-4628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2010 |
Last Update Date | 11/03/2011 |