Provider Demographics
NPI:1194421339
Name:MARTIN, REECE CHRISTOPHERSON (PA-C)
Entity type:Individual
Prefix:
First Name:REECE
Middle Name:CHRISTOPHERSON
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 GATEWAY PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1840
Mailing Address - Country:US
Mailing Address - Phone:913-269-0979
Mailing Address - Fax:
Practice Address - Street 1:1401 AVOCADO AVE STE 307
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-8732
Practice Address - Country:US
Practice Address - Phone:949-720-1944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62263363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant