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NPI Code Detail

MEDICARE: MR. RONALD BERNARD MARTIN JR.

MEDICARE: MR. RONALD BERNARD MARTIN JR.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1215419288
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RONALD BERNARD MARTIN JR.
Provider Business Mailing Address
First Line : 18646 OXNARD ST
Second Line :
City : TARZANA
State : CA
Zip : 91356-1486
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 18646 OXNARD ST
Second Line :
City : TARZANA
State : CA
Zip : 91356-1486
Country : US
Telephone Number : 818-996-1051
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2018
Last Update Date : 02/16/2021

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