MEDICARE: LILIA MARTINEZ D.D.S. INC.

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
1	261QD0000X	Dental Clinic/Center	41113	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366658403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LILIA MARTINEZ D.D.S. INC.

Provider Business Mailing Address
First Line	:	176 S ALVARADO ST
Second Line	:	204
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2218
Country	:	US
Telephone Number	:	213-484-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	176 S ALVARADO ST
Second Line	:	204
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2218
Country	:	US
Telephone Number	:	213-484-1500
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LILI MARTINEZ
Credential	:
Telephone Number	:	213-484-1500

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	02/18/2015

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