MEDICARE: DR. TERRIN E MARTIN M.D.

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	207L00000X	Anesthesiology Physician	A99078	CA

General Provider Information

NPI Number	:	1295921229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRIN E MARTIN M.D.

Provider Business Mailing Address
First Line	:	1411 N DETROIT ST
Second Line	:	UNIT 103
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-4488
Country	:	US
Telephone Number	:	310-482-8550
Fax Number	:

Provider Business Practice Location Address
First Line	:	1411 N DETROIT ST
Second Line	:	UNIT 103
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-4488
Country	:	US
Telephone Number	:	310-482-8550
Fax Number	:

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

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	07/23/2014

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