Provider Demographics
NPI:1124483326
Name:MARTYN CANINE BEHAVIOR
Entity type:Organization
Organization Name:MARTYN CANINE BEHAVIOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:MARTYN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:650-898-9117
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:
Mailing Address - City:EL VERANO
Mailing Address - State:CA
Mailing Address - Zip Code:95433-0268
Mailing Address - Country:US
Mailing Address - Phone:650-898-9117
Mailing Address - Fax:
Practice Address - Street 1:3735 BIG FLAT RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-9418
Practice Address - Country:US
Practice Address - Phone:650-898-9117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies