MEDICARE: ANTONIO MARTINEZ

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	363LF0000X	Family Nurse Practitioner	14182	CA

General Provider Information

NPI Number	:	1528236981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIO MARTINEZ

Provider Business Mailing Address
First Line	:	4111 MAINE AVE
Second Line	:
City	:	BALDWIN PARK
State	:	CA
Zip	:	91706-3307
Country	:	US
Telephone Number	:	323-369-0955
Fax Number	:	626-517-5482

Provider Business Practice Location Address
First Line	:	1983 MARENGO ST
Second Line	:	DEM
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1370
Country	:	US
Telephone Number	:	323-369-0955
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	09/09/2024

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Directions to “ ANTONIO MARTINEZ ” Practice Location

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