Elliott O Martinez, IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

State Road 108 BLDG 3005
Dewert Branch Health Clinic
Bridgeport, CA 93517-7777

Phone

(760) 932-1616

Fax

(760) 932-1623

NPI assigned

Aug 19, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1187481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445558400000",
    "number": "1871786335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "S.R. 108 BLDG 3005",
            "city": "BRIDGEPORT",
            "state": "CA",
            "postal_code": "93517",
            "telephone_number": "760-932-1616",
            "fax_number": "760-932-1623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "STATE ROAD 108 BLDG 3005",
            "address_2": "DEWERT BRANCH HEALTH CLINIC",
            "city": "BRIDGEPORT",
            "state": "CA",
            "postal_code": "935177777",
            "telephone_number": "760-932-1616",
            "fax_number": "760-932-1623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEZ",
        "first_name": "ELLIOTT",
        "middle_name": "O",
        "credential": "IDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-19",
        "last_updated": "2015-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• County of Mono (Mono County Emergency Medical Services)
• Philip Gernert
• Michael Gumpert, PA
• Toby Natividad Hernandez, IDC
• Ryan Stephen Hildebrand, IDC
• Caleb Lee McNeal, PA-C
• Mono County Office of Education
• Naval Hospital Camp Pendleton (Camp Pend 43 Abmc WCC Phcy)
• Naval Hospital Twentynine Palms
• Amanda Philips

• Independent Duty Corpsman in Bridgeport, CA
• Providers in Bridgeport, CA by specialty
• Independent Duty Corpsman in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.