Healthcare Provider Details

I. General information

NPI: 1871741850
Provider Name (Legal Business Name): CARLOS MARTINEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13132 NEWPORT AVE STE 100
TUSTIN CA
92780-3429
US

IV. Provider business mailing address

13132 NEWPORT AVE STE 100
TUSTIN CA
92780-3429
US

V. Phone/Fax

Practice location:
  • Phone: 714-565-7960
  • Fax: 714-565-7982
Mailing address:
  • Phone: 714-565-7960
  • Fax: 714-565-7982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA103553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: