Healthcare Provider Details

I. General information

NPI: 1285233759
Provider Name (Legal Business Name): DAEMIAN ALEXANDER MARTIN SR. RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2020
Last Update Date: 10/25/2020
Certification Date: 10/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST
LOMA LINDA CA
92354-2804
US

IV. Provider business mailing address

35258 HOGAN DR
BEAUMONT CA
92223-7407
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4000
  • Fax:
Mailing address:
  • Phone: 951-662-9195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number845192
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: