Healthcare Provider Details

I. General information

NPI: 1720125990
Provider Name (Legal Business Name): ROBERT LEE MARTIN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7750 UNIVERSITY AVE STE C
LA MESA CA
91942-4948
US

IV. Provider business mailing address

7750 UNIVERSITY AVE STE C
LA MESA CA
91942-4948
US

V. Phone/Fax

Practice location:
  • Phone: 619-697-9339
  • Fax:
Mailing address:
  • Phone: 619-697-9339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU 296
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: