Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 34.014062 | OH |
NPI | 1003303751 |
---|---|
Provider Name | Lara Martinez |
First Address | Dayton, OH 45405-7538 |
Second Address | Dayton, OH 45405-7538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2018 |
Last Update Date | 20/10/2021 |