Individual
MR. NATHAN BLUEHAWK MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RDA
Contact information
Practice address
154 W FOOTHILL BLVD, MONROVIA, CA 91016-2171
(909) 450-6842
Mailing address
154 W FOOTHILL BLVD, MONROVIA, CA 91016-2171
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
49553
CA
Other
Enumeration date
09/08/2017
Last updated
09/08/2017
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