Individual provider Active NPI

Antonio Martinez

  • Family Nurse Practitioner
  • Los Angeles, CA
National Provider Identifier
1528236981
Registry record updated Sep 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
14182 Issued in CA
Practice address
1983 Marengo St
Dem
Los Angeles, CA 90033-1370
Phone
(323) 369-0955
NPI assigned
Feb 19, 2008
Last updated
Sep 9, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 14182 CA Primary

Addresses

Primary practice location

1983 Marengo St
Dem
Los Angeles, CA 90033-1370

Mailing address

4111 Maine Ave
Baldwin Park, CA 91706-3307
Phone (323) 369-0955

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081231000373 CA Practitioner - Nurse Practitioner 1557423431 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4111 Maine Ave
Baldwin Park, CA 91706-3307
Phone (626) 939-0676

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
14182CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Mitla Professional Nursing Care, Inc CurrentSince Apr 29, 2024 Accepting new patients

Locations

4111 Maine Ave
Baldwin Park, CA 91706
Phone (626) 939-0676

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1203379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725840000000",
    "number": "1528236981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4111 MAINE AVE",
            "city": "BALDWIN PARK",
            "state": "CA",
            "postal_code": "917063307",
            "telephone_number": "323-369-0955",
            "fax_number": "626-517-5482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1983 MARENGO ST",
            "address_2": "DEM",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900331370",
            "telephone_number": "323-369-0955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEZ",
        "first_name": "ANTONIO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-19",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "14182",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.