Individual
GINA MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
3990 ABBEY LN STE 101B, ASTORIA, OR 97103-2237
(503) 841-1165
Mailing address
1544 5TH ST, ASTORIA, OR 97103-5313
(503) 841-1165
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
17620
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336415660
—
OR
Enumeration date
03/30/2012
Last updated
12/08/2018
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