Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | A118831 | CA |
NPI | 1134423684 |
---|---|
Provider Name | Luis Martinez |
First Address | Fresno, CA 93729-8949 |
Second Address | Fresno, CA 93720-3303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2010 |
Last Update Date | 27/06/2013 |