Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | MT196590 | PA |
NPI | 1013234251 |
---|---|
Provider Name | Hector Fernando Martinez-Wilson |
First Address | San Diego, CA 92127-7720 |
Second Address | Escondido, CA 92029-4206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2010 |
Last Update Date | 02/07/2014 |