Provider Demographics
NPI:1104296763
Name:LLAMAS, MARTIN LAWERENCE JOSE
Entity type:Individual
Prefix:
First Name:MARTIN LAWERENCE
Middle Name:JOSE
Last Name:LLAMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3813 ELSMERE AVE
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3819
Mailing Address - Country:US
Mailing Address - Phone:626-628-5908
Mailing Address - Fax:
Practice Address - Street 1:2045 JEFFERSON DR
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-1732
Practice Address - Country:US
Practice Address - Phone:626-628-5908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer