Healthcare Provider Details

I. General information

NPI: 1558725572
Provider Name (Legal Business Name): DEBORAH BRUNO MARTINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST DEPT OF
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

57 DAPPLEGRAY RD
BELL CANYON CA
91307-1010
US

V. Phone/Fax

Practice location:
  • Phone: 424-955-1156
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA152842
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberA152842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: