Individual
ELLIOTT O MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
STATE ROAD 108 BLDG 3005, DEWERT BRANCH HEALTH CLINIC, BRIDGEPORT, CA 93517-7777
(760) 932-1616
(760) 932-1623
Mailing address
S.R. 108 BLDG 3005, BRIDGEPORT, CA 93517
(760) 932-1616
(760) 932-1623
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
08/19/2007
Last updated
10/23/2015
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