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General NPI Number Information
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NPI Number | 1275701401
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Entity Type | Individual
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Provider Name | MARTIN AURELIO OTR/L
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Gender | Male
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Dates
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Enumeration Date | 02/11/2008
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Last Update Date | 04/02/2010
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Provider Practice Location Address
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Address Line | 101 W AMERICAN CANYON RD STE 580-279
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City | AMERICAN CANYON
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State | CA
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Zip | 94503-1162
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Country | US
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Telephone | 707-853-0315
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Fax |
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Provider Business Mailing Address
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Address Line | 101 W AMERICAN CANYON RD STE 580-279
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City | AMERICAN CANYON
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State | CA
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Zip | 94503-1162
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Country | US
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Telephone | 707-853-0315
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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 | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | OT- 2047
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License Number State | CA
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