MEDICARE: DR. INGRID L MARTINEZ-ANDREE MD

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	208000000X	Pediatrics Physician	A63054	CA

General Provider Information

NPI Number	:	1205807203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. INGRID L MARTINEZ-ANDREE MD

Provider Business Mailing Address
First Line	:	3860 CALLE FORTUNADA
Second Line	:	SUITE 200
City	:	SAN DIEGO
State	:	CA
Zip	:	92123
Country	:	US
Telephone Number	:	858-636-4300
Fax Number	:	858-636-4319

Provider Business Practice Location Address
First Line	:	3030 CHILDRENS WAY
Second Line	:	#112
City	:	SAN DIEGO
State	:	CA
Zip	:	92123
Country	:	US
Telephone Number	:	858-495-0500
Fax Number	:	858-560-4279

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

Provider Enumeration Date	:	01/28/2006
Last Update Date	:	02/01/2011

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