Active NPI
Robert Demetric Martin, NP
- Acute Care Nurse Practitioner
- Los Angeles, CA
National Provider Identifier
1861621377
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acute Care Nurse Practitioner
- License
- 359085
- Practice address
- 1200 N State St
GH Room # 1011
Los Angeles, CA 90033-1029 - Phone
- (323) 409-6715
- NPI assigned
- Jul 6, 2009
- 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 |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | 359085 | CA | Primary |
Addresses
Primary practice location
1200 N State St
GH Room # 1011
Los Angeles, CA 90033-1029
Mailing address
1200 N State St
GH Room # 1011
Los Angeles, CA 90033-1029
Phone (323) 409-6715
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
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 359085 | CA | MD | Acute Care Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1246838400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1246838400000",
"number": "1861621377",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 N STATE ST",
"address_2": "GH ROOM # 1011",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900331029",
"telephone_number": "323-409-6715"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 N STATE ST",
"address_2": "GH ROOM # 1011",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900331029",
"telephone_number": "323-409-6715"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "ROBERT",
"middle_name": "DEMETRIC",
"name_prefix": "Mr.",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-07-06",
"last_updated": "2009-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "CA",
"license": "359085",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.