Basic Information
| Provider Information | |||||||||
| NPI: | 1013234251 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINEZ-WILSON | ||||||||
| FirstName: | HECTOR | ||||||||
| MiddleName: | FERNANDO | ||||||||
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| Credential: | MD, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16955 VIA DEL CAMPO | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921277720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586736100 | ||||||||
| FaxNumber: | 8586736113 | ||||||||
| Practice Location | |||||||||
| Address1: | 2185 WEST CITRACADO PARKWAY | ||||||||
| Address2: | |||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920294206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4422811000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2010 | ||||||||
| LastUpdateDate: | 07/02/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MT196590 | PA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 390200000X | MT196590 | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.