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General NPI Number Information
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NPI Number | 1134221252
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Entity Type | Individual
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Provider Name | MARTIN JOHN EATON PH.D.
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Gender | Male
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 12/13/2012
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Provider Practice Location Address
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Address Line | 222 W MAIN STREET SUITE 102
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City | TUSTIN
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State | CA
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Zip | 92780
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Country | US
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Telephone | 714-730-9355
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Fax | 714-730-9357
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Provider Business Mailing Address
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Address Line | 100 S. IMPERIAL HWY
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City | ANAHEIM HILLS
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State | CA
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Zip | 92807
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Country | US
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Telephone | 714-769-7600
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Fax | 714-866-4111
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY15533
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License Number State | CA
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