Healthcare Provider Details

I. General information

NPI: 1972667178
Provider Name (Legal Business Name): PAUL MARTIN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 02/04/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 SOLAR DR SUITE 261
OXNARD CA
93030-0134
US

IV. Provider business mailing address

1701 SOLAR DR SUITE 261
OXNARD CA
93030-0134
US

V. Phone/Fax

Practice location:
  • Phone: 805-660-0507
  • Fax:
Mailing address:
  • Phone: 805-660-0507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY15556
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: