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General NPI Number Information
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NPI Number | 1952604613
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Entity Type | Individual
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Provider Name | ELISE MARTIN
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Gender | Female
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Dates
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Enumeration Date | 12/17/2010
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Last Update Date | 05/24/2021
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Provider Practice Location Address
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Address Line | 10833 LECONTE AVE 37121 CHS
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City | LOS ANGELES
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State | CA
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Zip | 90095-0001
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Country | US
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Telephone | 310-825-7225
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Fax |
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Provider Business Mailing Address
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Address Line | 10833 LECONTE AVE 37121 CHS
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City | LOS ANGELES
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State | CA
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Zip | 90095-0001
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Country | US
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Telephone |
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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 | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | A119229
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License Number State | CA
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