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General NPI Number Information
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NPI Number | 1003363243
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Entity Type | Individual
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Provider Name | JUAN GERARDO MARTINEZ DDS
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Gender | Male
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Dates
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Enumeration Date | 09/06/2016
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Last Update Date | 10/19/2020
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Provider Practice Location Address
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Address Line | 490 N MAIN ST STE 207
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City | CORONA
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State | CA
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Zip | 92878-3461
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Country | US
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Telephone | 951-444-7010
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Fax | 951-444-7181
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Provider Business Mailing Address
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Address Line | 2919 WILLOW RD
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City | SAN PABLO
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State | CA
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Zip | 94806-3723
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Country | US
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Telephone | 510-697-1029
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DDS101781
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License Number State | CA
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