Individual
MISS LORI LOUISE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
576 JEFFERSON AVE, PRIMARY CARE CLINIC RM 330, FORT EUSTIS, VA 23604-1602
(757) 314-7613
Mailing address
797 S FAIR OAKS AVE, PASADENA, CA 91105-2617
(310) 621-6439
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA15787
CA
Other
Enumeration date
10/25/2005
Last updated
05/29/2014
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