Provider Demographics
NPI:1124167481
Name:MARTA, DENNIS LEE (DPM)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:LEE
Last Name:MARTA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 E TAHQUITZ CANYON WAY
Mailing Address - Street 2:SUITE #1
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7020
Mailing Address - Country:US
Mailing Address - Phone:760-325-1321
Mailing Address - Fax:760-320-0611
Practice Address - Street 1:2145 E TAHQUITZ CANYON WAY
Practice Address - Street 2:SUITE #1
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7020
Practice Address - Country:US
Practice Address - Phone:760-325-1321
Practice Address - Fax:760-320-0611
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1722213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
E17220Medicare UPIN
E17220Medicare ID - Type Unspecified