Individual
MR. MIGUEL ANGEL MARTINEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
18355 STALLION LN, 18355 STALLION LN, BLOOMINGTON, CA 92316-3142
(909) 644-2531
Mailing address
18355 STALLION LN, 18355 STALLION LN, BLOOMINGTON, CA 92316-3142
(909) 644-2531
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
460325
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
460325
DA CERIFICATE
CA
Enumeration date
10/01/2009
Last updated
10/01/2009
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