Basic Information
| Provider Information | |||||||||
| NPI: | 1770899304 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | ANDRES | ||||||||
| MiddleName: | K | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1680 E HILL ST | ||||||||
| Address2: | 3RD FL | ||||||||
| City: | SIGNAL HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907553612 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1111 W 6TH ST | ||||||||
| Address2: | #120 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900171823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2138950009 | ||||||||
| FaxNumber: | 2138950012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2010 | ||||||||
| LastUpdateDate: | 08/20/2010 | ||||||||
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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 | 1223P0221X | 59245 | CA | Y | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.