MEDICARE: MARTIN LEMUS BCABA

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	103K00000X	Behavior Analyst	0125172	CA

General Provider Information

NPI Number	:	1316281496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN LEMUS BCABA

Provider Business Mailing Address
First Line	:	PO BOX 122279
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91912-6979
Country	:	US
Telephone Number	:	619-691-1880
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 S IMPERIAL AVE STE 6
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-3149
Country	:	US
Telephone Number	:	760-353-8500
Fax Number	:

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

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	11/15/2012

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Directions to “ MARTIN LEMUS BCABA” Practice Location

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