Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CA11975 | CA |
NPI | 1801805866 |
---|---|
Provider Name | Mr. Charles Jonathan Martin |
First Address | Monterey, CA 93940-4521 |
Second Address | Monterey, CA 93940-4521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 02/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T04573 | (02) |