MEDICARE: MARTINEZ MEDICAL CLINIC

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	261Q00000X	Clinic/Center	A17556	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285815092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTINEZ MEDICAL CLINIC

Provider Business Mailing Address
First Line	:	1150 N HACIENDA BLVD
Second Line	:
City	:	LA PUENTE
State	:	CA
Zip	:	91744-2023
Country	:	US
Telephone Number	:	626-917-5281
Fax Number	:	626-917-5411

Provider Business Practice Location Address
First Line	:	1150 N HACIENDA BLVD
Second Line	:
City	:	LA PUENTE
State	:	CA
Zip	:	91744-2023
Country	:	US
Telephone Number	:	626-917-5281
Fax Number	:	626-917-5411

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EMIL T MARTINEZ
Credential	:	MD
Telephone Number	:	626-917-5281

Provider Enumeration Date	:	11/20/2007
Last Update Date	:	02/29/2008

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Directions to “MARTINEZ MEDICAL CLINIC ” Practice Location

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