Healthcare Provider Details

I. General information

NPI: 1083317341
Provider Name (Legal Business Name): KATHLEEN SARAH MARTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 HIGHLAND SPRINGS AVE
BEAUMONT CA
92223-3176
US

IV. Provider business mailing address

81 HIGHLAND SPRINGS AVE
BEAUMONT CA
92223-3176
US

V. Phone/Fax

Practice location:
  • Phone: 909-580-3366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA205003
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: