Lance Eric Martinez, M.D.
Individual provider Active NPI Pediatrics Physician · Fairfax, CA
NPI 1710013974 · NPPES record last updated Feb 11, 2022
Key facts
- NPI
- 1710013974
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- A66638 (CA)
- Practice address
- 74 Spruce Rd
Fairfax, CA 94930-1570 - Phone
- (415) 453-8883
- NPI assigned
- Feb 24, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070604000295 | CA | Practitioner - Pediatric Medicine | 5092813774 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A66638 | CA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Permanente Medical Group, Inc | Current |
Accepting new patients | |
| Permanente Medical Group Inc | Pediatrics | Current | Accepting new patients |
| Permanente Medical Group Inc | Pediatrics | Current |
Accepting new patients |
Locations
1800 Harrison St
Fl 7
Oakland, CA 94612
1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015
901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500
2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000
710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400
401 Bicentennial Way
Santa Rosa, CA 95403
Phone (707) 393-4000
7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000
975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A66638 | CA | Yes |
Addresses
Primary practice location
74 Spruce Rd
Fairfax, CA 94930-1570
Mailing address
74 Spruce Rd
Fairfax, CA 94930-1570
Phone (415) 453-8883
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq | Health Information Exchange (HIE) | The Permanente Medical Group |
Other providers in Fairfax, CA
- Jason Neal Linder
- Amy Cecile Logan
- Nancy Lee Malloy
- Pamela Grace Manwaring
- Marin Holistic Health & Acupuncture, Inc
- Anya Maruscha
- Rainiero Miranda
- Isabel Teresa Mize
- Heather Moore
- Sarah Mullin
All providers in Fairfax, CA · Pediatrics Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 11, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.