Healthcare Provider Details

I. General information

NPI: 1053874305
Provider Name (Legal Business Name): TRAVIS PATRICK MARTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25915 BARTON RD STE 204
LOMA LINDA CA
92354
US

IV. Provider business mailing address

1111 6TH AVE SUITE 505 PMB 692133
SAN DIEGO CA
92101-5209
US

V. Phone/Fax

Practice location:
  • Phone: 951-724-4947
  • Fax:
Mailing address:
  • Phone: 951-724-4947
  • Fax: 443-342-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA184909
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA184909
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: