Healthcare Provider Details

I. General information

NPI: 1104313220
Provider Name (Legal Business Name): REBECA M. MARTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W ROWLAND ST
COVINA CA
91723-2943
US

IV. Provider business mailing address

4938 COMPOSITION CT
OCEANSIDE CA
92057-7914
US

V. Phone/Fax

Practice location:
  • Phone: 626-331-6411
  • Fax:
Mailing address:
  • Phone: 201-889-0181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA174550
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: