Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DDS101781 | CA |
Y | 213EG0000X | General Practice | DDS101781 | CA |
NPI | 1003363243 |
---|---|
Provider Name | Juan Gerardo Martinez |
First Address | San Pablo, CA 94806-3723 |
Second Address | Corona, CA 92878-3461 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2016 |
Last Update Date | 19/10/2020 |