Individual
MARK MARTINEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
13520 BONA VISTA LN, LA MIRADA, CA 90638-2803
(562) 921-6423
Mailing address
13520 BONA VISTA LN, LA MIRADA, CA 90638-2803
(562) 921-6423
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT2847
CA
Other
Enumeration date
05/10/2012
Last updated
05/10/2012
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