Organization
N/A
Active
Organization
N/A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN ROLAND MARTIN (PHLEBOTOMIST)
(925) 458-5124
Entity
Organization
Contact information
Practice address
4051 LONE TREE WAY STE C, ANTIOCH, CA 94531-6204
(925) 757-2900
Mailing address
1869 SAN ANDRES DR, PITTSBURG, CA 94565-7651
(925) 458-5124
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
246RP1900X
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
93015226E48032
CA
CA
Enumeration date
01/04/2010
Last updated
01/04/2010
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