Provider Demographics
NPI:1407517907
Name:MARTIN, DYLAN CARY (EMT)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:CARY
Last Name:MARTIN
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 N PLANO ST
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-6329
Mailing Address - Country:US
Mailing Address - Phone:559-793-5519
Mailing Address - Fax:
Practice Address - Street 1:770 N PLANO ST
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-6329
Practice Address - Country:US
Practice Address - Phone:559-793-5519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB19-11185207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services