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NPI Code Detail

MEDICARE: FERNANDO MARTINEZ

MEDICARE: FERNANDO MARTINEZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health Worker
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1053648949
Entity Type Code : Individual
Provider Name (Legal Business Name) : FERNANDO MARTINEZ
Provider Business Mailing Address
First Line : 3512 1/2 GLEASON AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90063-2926
Country : US
Telephone Number : 323-307-0152
Fax Number : 323-307-0161
Provider Business Practice Location Address
First Line : 3055 WILSHIRE BLVD STE 300
Second Line :
City : LOS ANGELES
State : CA
Zip : 90010-1147
Country : US
Telephone Number : 213-375-3830
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2009
Last Update Date : 01/03/2019

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Directions to “ FERNANDO MARTINEZ ” Practice Location

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