Healthcare Provider Details

I. General information

NPI: 1770733255
Provider Name (Legal Business Name): DANIEL MARTINO PA-C, CAQ-PSYCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2008
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12725 SW MILLIKAN WAY STE 300
BEAVERTON OR
97005-1687
US

IV. Provider business mailing address

582 MARKET ST STE 1608
SAN FRANCISCO CA
94104-5317
US

V. Phone/Fax

Practice location:
  • Phone: 833-931-1716
  • Fax: 866-519-5427
Mailing address:
  • Phone: 833-931-1716
  • Fax: 866-519-5427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA150160
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberPA150160
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA64078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: