MEDICARE: MARTIN GREENBERG

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	2084P0800X	Psychiatry Physician	A23007	CA

General Provider Information

NPI Number	:	1710016837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN GREENBERG

Provider Business Mailing Address
First Line	:	9505 GENESEE AVE
Second Line	:	# 532
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-2005
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5500 CAMPANILE DR
Second Line	:	STUDENT HEALTH-SDSU
City	:	SAN DIEGO
State	:	CA
Zip	:	92182-0001
Country	:	US
Telephone Number	:	619-594-7316
Fax Number	:	619-594-7470

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/08/2007

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Directions to “ MARTIN GREENBERG ” Practice Location

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