Healthcare Provider Details

I. General information

NPI: 1770564155
Provider Name (Legal Business Name): DANIEL SCOTT MARTINEAU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 12/21/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

560 KINSALE CT
VACAVILLE CA
95688-9205
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-7176
  • Fax: 707-423-7446
Mailing address:
  • Phone: 707-423-7176
  • Fax: 707-423-7446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberG87245
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: