Healthcare Provider Details

I. General information

NPI: 1265964779
Provider Name (Legal Business Name): PIERRE RODRICUS MARTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVENUE BLDG. 5, #4M
SAN FRANCISCO CA
94110
US

IV. Provider business mailing address

1001 POTRERO AVENUE BLDG. 5, #4M
SAN FRANCISCO CA
94110
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA160030
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: