Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013676501 |
---|---|
Provider Name | Mr. Steve Randy Martinez |
First Address | Sylmar, CA 91342-1470 |
Second Address | Van Nuys, CA 91406-3345 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2021 |
Last Update Date | 11/12/2021 |