Healthcare Provider Details

I. General information

NPI: 1003758640
Provider Name (Legal Business Name): LUIS MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

3530 WILSHIRE BLVD STE 1220
LOS ANGELES CA
90010-2341
US

IV. Provider business mailing address

3530 WILSHIRE BLVD STE 1220
LOS ANGELES CA
90010-2341
US

V. Phone/Fax

Practice location:
  • Phone: 323-305-3967
  • Fax: 323-694-7563
Mailing address:
  • Phone: 323-305-3967
  • Fax: 323-694-7563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: