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General NPI Number Information
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NPI Number | 1255537957
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Entity Type | Organization
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Legal Business Name | KENNETH P MARTINEZ MD A MEDICAL CORP
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Dates
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Enumeration Date | 06/21/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5 JOURNEY STE 210
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City | ALISO VIEJO
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State | CA
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Zip | 92656-5332
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Country | US
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Telephone | 949-305-7122
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Fax | 949-305-7160
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Provider Business Mailing Address
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Address Line | 5 JOURNEY SUITE 210
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City | ALISO VIEJO
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State | CA
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Zip | 92656-5336
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Country | US
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Telephone | 949-305-7122
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Fax | 949-305-7160
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Authorized Official
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Title or Position | NEUROLOGIST
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Name | KENNETH PATRICK MARTINEZ
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Credential | MD
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Telephone | 949-305-7122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State | CA
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