Provider Demographics
NPI:1306886304
Name:MARTELLI, MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MARTELLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4849 RONSON CT
Mailing Address - Street 2:STE 217
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1805
Mailing Address - Country:US
Mailing Address - Phone:858-279-1212
Mailing Address - Fax:858-279-1420
Practice Address - Street 1:275 N EL CIELO RD STE D-402
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6972
Practice Address - Country:US
Practice Address - Phone:310-650-6729
Practice Address - Fax:760-775-5604
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4955207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX49550Medicaid
CAC46831Medicare UPIN
CAH20A4955AMedicare PIN
CA00AX49550Medicaid