Provider Demographics
NPI:1528136801
Name:MARTIN, WENDY GAIL (MD)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:GAIL
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 THUNDER DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6010
Mailing Address - Country:US
Mailing Address - Phone:760-630-5487
Mailing Address - Fax:760-630-2558
Practice Address - Street 1:2095 W VISTA WAY STE 218
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6029
Practice Address - Country:US
Practice Address - Phone:760-630-3562
Practice Address - Fax:760-630-2559
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45303207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A453030Medicaid
CA5346695OtherAETNA
CA5346695OtherAETNA
CAWA45303BMedicare PIN
CAB49325Medicare UPIN