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General NPI Number Information
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NPI Number | 1972738557
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Entity Type | Individual
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Provider Name | JOHN EDWARD MARTIN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/26/2009
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Last Update Date | 09/17/2014
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Provider Practice Location Address
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Address Line | 4510 E PACIFIC COAST HWY SUITE 210
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City | LONG BEACH
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State | CA
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Zip | 90804-3279
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Country | US
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Telephone | 877-651-3370
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Fax |
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Provider Business Mailing Address
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Address Line | 375 REDONDO AVE # 286
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City | LONG BEACH
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State | CA
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Zip | 90814-8130
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Country | US
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Telephone | 877-651-3370
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 11498
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License Number State | CA
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