Individual
ANDREI MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6338 W PORT ROYALE LN, GLENDALE, AZ 85306-3260
(623) 487-0488
(623) 487-0488
Mailing address
6338 W PORT ROYALE LN, GLENDALE, AZ 85306-3260
(623) 487-0488
(623) 487-0488
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL5696H
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023450
—
AZ
Enumeration date
07/02/2018
Last updated
07/02/2018
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