Healthcare Provider Details

I. General information

NPI: 1770505844
Provider Name (Legal Business Name): MARTIN ELI EISNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 N TUSTIN AVE STE 109
SANTA ANA CA
92705-6504
US

IV. Provider business mailing address

PO BOX 62316
IRVINE CA
92602-6077
US

V. Phone/Fax

Practice location:
  • Phone: 714-756-4820
  • Fax: 714-953-3425
Mailing address:
  • Phone: 714-731-7871
  • Fax: 714-731-7872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG43023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: