Healthcare Provider Details

I. General information

NPI: 1164673299
Provider Name (Legal Business Name): ANA LILIA MARTINEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA LILIA MARTINEZ M.D.

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 E WALNUT ST 3RD FLOOR - PHRS
PASADENA CA
91188-0001
US

IV. Provider business mailing address

393 E WALNUT ST 3RD FLOOR - PHRS
PASADENA CA
91188-0001
US

V. Phone/Fax

Practice location:
  • Phone: 626-405-7914
  • Fax:
Mailing address:
  • Phone: 626-405-7914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA93738
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: