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General NPI Number Information
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NPI Number | 1609990209
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Entity Type | Organization
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Legal Business Name | WILLIAM W MARTIN PHD PC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 03/07/2018
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Provider Practice Location Address
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Address Line | 665 CAMINO DE LOS MARES SUITE 104
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City | SAN CLEMENTE
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State | CA
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Zip | 92673
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Country | US
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Telephone | 949-248-7377
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Fax | 866-805-2796
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Provider Business Mailing Address
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Address Line | 665 CAMINO DE LOS MARES SUITE 104
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City | SAN CLEMENTE
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State | CA
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Zip | 92673
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Country | US
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Telephone | 949-248-7377
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Fax | 866-805-2796
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM W. MARTIN
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Credential | PH.D.
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Telephone | 949-248-7377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY9840
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License Number State | CA
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