Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT17853 | CA |
N | 2251E1200X | Ergonomics | PT17853 | CA |
N | 225XE1200X | Ergonomics | PT17853 | CA |
N | 2251N0400X | Physical Therapist - Neurology | PT17853 | CA |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT17853 | CA |
NPI | 1619317658 |
---|---|
Provider Name | Francisco Javier Martinez |
First Address | Lancaster, CA 93536-5229 |
Second Address | Lancaster, CA 93536-5229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2013 |
Last Update Date | 29/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0PT178530 | BLUE SHIELD PIN (01) | CA |
PT17853 | PT LICENSE (01) | CA |