MEDICARE: SEMPER MEDICAL CENTER

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	261QP2300X	Primary Care Clinic/Center	PA21107	CA

General Provider Information

NPI Number	:	1700160884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEMPER MEDICAL CENTER

Provider Business Mailing Address
First Line	:	1750 HUNTINGTON DR
Second Line	:	SUITE B
City	:	DUARTE
State	:	CA
Zip	:	91010-2536
Country	:	US
Telephone Number	:	626-930-1600
Fax Number	:	626-930-1655

Provider Business Practice Location Address
First Line	:	1750 HUNTINGTON DR
Second Line	:	SUITE B
City	:	DUARTE
State	:	CA
Zip	:	91010-2536
Country	:	US
Telephone Number	:	626-930-1600
Fax Number	:	626-930-1655

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROBERT MAXX MARTINEZ I
Credential	:	MPAP, PA-C
Telephone Number	:	818-653-4299

Provider Enumeration Date	:	10/06/2011
Last Update Date	:	03/20/2012

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Directions to “SEMPER MEDICAL CENTER ” Practice Location

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