Provider Demographics
NPI:1720541048
Name:MARTIN, ELAINE CHRISTINE (MD)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:CHRISTINE
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 1:2240 N HARBOR BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-2635
Mailing Address - Country:US
Mailing Address - Phone:714-447-4100
Mailing Address - Fax:714-447-1922
Practice Address - Street 1:2240 N HARBOR BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2635
Practice Address - Country:US
Practice Address - Phone:714-447-4100
Practice Address - Fax:714-447-4100
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA178619207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program