Healthcare Provider Details

I. General information

NPI: 1790753770
Provider Name (Legal Business Name): MARTIN L CHARLAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SANTA FE DR SUITE 204
ENCINITAS CA
92024-5138
US

IV. Provider business mailing address

320 SANTA FE DR STE 204
ENCINITAS CA
92024-5179
US

V. Phone/Fax

Practice location:
  • Phone: 760-944-7300
  • Fax: 760-634-6566
Mailing address:
  • Phone: 760-944-7300
  • Fax: 760-634-6566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG64921
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: