Healthcare Provider Details

I. General information

NPI: 1679764450
Provider Name (Legal Business Name): JONATHAN P MARTINEZ D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2270 E PALMDALE BLVD SUITE F
PALMDALE CA
93550-4933
US

IV. Provider business mailing address

2270 E PALMDALE BLVD SUITE F
PALMDALE CA
93550-4933
US

V. Phone/Fax

Practice location:
  • Phone: 661-947-5600
  • Fax: 661-947-5900
Mailing address:
  • Phone: 661-947-5600
  • Fax: 661-947-5900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number20A9822
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: