Healthcare Provider Details

I. General information

NPI: 1699194753
Provider Name (Legal Business Name): ROBERT MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S MILLER ST STE 108
SANTA MARIA CA
93454-5248
US

IV. Provider business mailing address

201 S MILLER ST STE 108
SANTA MARIA CA
93454-5248
US

V. Phone/Fax

Practice location:
  • Phone: 805-925-9811
  • Fax: 805-925-9706
Mailing address:
  • Phone: 805-925-9811
  • Fax: 805-925-9706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: