Healthcare Provider Details

I. General information

NPI: 1437476421
Provider Name (Legal Business Name): SCOTT M. MARTIN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 JOURNEY SUITE 220
ALISO VIEJO CA
92656-5336
US

IV. Provider business mailing address

5 JOURNEY SUITE 220
ALISO VIEJO CA
92656-5336
US

V. Phone/Fax

Practice location:
  • Phone: 949-305-7122
  • Fax: 949-305-7160
Mailing address:
  • Phone: 949-305-7122
  • Fax: 949-305-7160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA94122
License Number StateCA

VIII. Authorized Official

Name: DR. SCOTT MATTHEW MARTIN
Title or Position: CEO
Credential: M.D.
Phone: 949-444-1413