Healthcare Provider Details

I. General information

NPI: 1215189709
Provider Name (Legal Business Name): MARTIN J CLINE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 PANORAMIC HIGHWAY
STINSON BEACH CA
94970-0905
US

IV. Provider business mailing address

6901 PANORAMIC HIGHWAY
STINSON BEACH CA
94970-0905
US

V. Phone/Fax

Practice location:
  • Phone: 415-868-1358
  • Fax:
Mailing address:
  • Phone: 415-868-1358
  • Fax: 415-868-2760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License NumberG8637
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: