Healthcare Provider Details

I. General information

NPI: 1588313282
Provider Name (Legal Business Name): MARIAN MARTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 CUYAMACA ST
SANTEE CA
92071-4253
US

IV. Provider business mailing address

5651 COPLEY DR STE A
SAN DIEGO CA
92111-7903
US

V. Phone/Fax

Practice location:
  • Phone: 858-499-2701
  • Fax:
Mailing address:
  • Phone: 858-541-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA191152
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: