Healthcare Provider Details

I. General information

NPI: 1760749253
Provider Name (Legal Business Name): JOSHUA JAY MARTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11370 ANDERSON ST
LOMA LINDA CA
92354-3450
US

IV. Provider business mailing address

FILE NUMBER 54701
LOS ANGELES CA
90074-4701
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-2880
  • Fax:
Mailing address:
  • Phone: 909-651-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License NumberA149177
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: