Active NPI
Mark Kevin Martin
- Recreation Therapist
- Long Beach, CA
National Provider Identifier
1346300043
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- Practice address
- 1975 Long Beach Blvd
Long Beach, CA 90806-5501 - Phone
- (562) 218-4091
- Fax
- (562) 599-3934
- NPI assigned
- Dec 11, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | Primary |
Addresses
Primary practice location
1975 Long Beach Blvd
Long Beach, CA 90806-5501
Mailing address
12771 Martha Ann Dr
Los Alamitos, CA 90720-4921
Phone (562) 430-2178
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1346300043",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12771 MARTHA ANN DR",
"city": "LOS ALAMITOS",
"state": "CA",
"postal_code": "907204921",
"telephone_number": "562-430-2178",
"fax_number": "562-599-3934"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1975 LONG BEACH BLVD",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908065501",
"telephone_number": "562-218-4091",
"fax_number": "562-599-3934"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "MARK",
"middle_name": "KEVIN",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Long Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.