Individual
WALTER IVAN MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11843 GILMORE ST APT 210, NORTH HOLLYWOOD, CA 91606-2857
(818) 818-7362
Mailing address
11843 GILMORE ST APT 210, NORTH HOLLYWOOD, CA 91606-2857
(818) 818-7362
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
86972
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
86972
—
CA
Enumeration date
08/21/2020
Last updated
08/21/2020
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