Healthcare Provider Details

I. General information

NPI: 1013234251
Provider Name (Legal Business Name): HECTOR FERNANDO MARTINEZ-WILSON MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2185 WEST CITRACADO PARKWAY
ESCONDIDO CA
92029-4206
US

IV. Provider business mailing address

16955 VIA DEL CAMPO SUITE 215
SAN DIEGO CA
92127-7720
US

V. Phone/Fax

Practice location:
  • Phone: 442-281-1000
  • Fax:
Mailing address:
  • Phone: 858-673-6100
  • Fax: 858-673-6113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMT196590
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT196590
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: