Provider Demographics
NPI:1063215788
Name:MARTIN, ALEXZANDER STONE LEE
Entity type:Individual
Prefix:
First Name:ALEXZANDER
Middle Name:STONE LEE
Last Name:MARTIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58457 29 PALMS HWY STE 102A
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-5879
Mailing Address - Country:US
Mailing Address - Phone:760-228-9657
Mailing Address - Fax:
Practice Address - Street 1:58457 29 PALMS HWY STE 102A
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-5879
Practice Address - Country:US
Practice Address - Phone:760-228-9657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-28
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist