MEDICARE: DR. BEVERLY K MARTINSONS DDS

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
1	1223G0001X	General Practice Dentistry	48328	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	FHC70961F	OTHER		MEDI-CAL

General Provider Information

NPI Number	:	1073616546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEVERLY K MARTINSONS DDS

Provider Business Mailing Address
First Line	:	4004 BEYER BLVD
Second Line	:
City	:	SAN YSIDRO
State	:	CA
Zip	:	92173-2007
Country	:	US
Telephone Number	:	619-428-4463
Fax Number	:	619-428-2625

Provider Business Practice Location Address
First Line	:	2 N EUCLID AVE SUITE #A B C
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-1967
Country	:	US
Telephone Number	:	619-205-6363
Fax Number	:	619-263-4247

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	07/08/2007

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