Individual
URI MARTIN ZISBLATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
210 W SAN BERNARDINO RD, DEPT OF RAD ONC, COVINA, CA 91723-1515
(626) 915-6280
(626) 859-5829
Mailing address
210 W SAN BERNARDINO RD, DEPT OF RAD ONC, COVINA, CA 91723-1515
(626) 915-6280
(626) 859-5829
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
G80195
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G801950
—
CA
01
—
4988508
CIGNA PROVIDER #
CA
01
—
5568573
AETNA
CA
01
—
920003242
RAILROAD MEDICARE
—
01
—
P00796214
RAILROAD MEDICARE
CA
Enumeration date
06/13/2005
Last updated
03/19/2014
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