Provider Demographics
NPI:1962560235
Name:DEO MARTINEZ MD PC
Entity type:Organization
Organization Name:DEO MARTINEZ MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER CHIEF FINANCIAL OFFI
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:SANDOVAL
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-656-1660
Mailing Address - Street 1:PO BOX 1350
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92556-1350
Mailing Address - Country:US
Mailing Address - Phone:951-656-1660
Mailing Address - Fax:951-656-2060
Practice Address - Street 1:13050 HEACOCK ST
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-1350
Practice Address - Country:US
Practice Address - Phone:951-656-1660
Practice Address - Fax:951-656-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32000207R00000X, 207RE0101X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Not Answered207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Not Answered207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0021600Medicaid
A26670Medicare UPIN
ZZZ97115ZMedicare ID - Type UnspecifiedMEDICARE GROUP PROV #
00A32000Medicare ID - Type Unspecified