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General NPI Number Information
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NPI Number | 1184307035
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Entity Type | Individual
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Provider Name | ELIJAH DAVION MARTIN CNA
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Gender | Male
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Dates
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Enumeration Date | 08/08/2023
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Last Update Date | 08/12/2023
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Provider Practice Location Address
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Address Line | 1117 E 125TH ST # THC
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City | CLEVELAND
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State | OH
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Zip | 44112-4127
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Country | US
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Telephone | 347-387-6749
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Fax |
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Provider Business Mailing Address
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Address Line | 544 DAVIS AVE # 1R
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City | STATEN ISLAND
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State | NY
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Zip | 10310-2904
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Country | US
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Telephone | 732-765-2115
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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