Active NPI
Ronald Martinez, PA
- Physician Assistant
- West Covina, CA
National Provider Identifier
1912954348
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA11411
- Practice address
- 1115 S Sunset Ave
West Covina, CA 91790-3940 - Phone
- (626) 814-2434
- NPI assigned
- May 30, 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA11411 | CA | Primary |
Addresses
Primary practice location
1115 S Sunset Ave
West Covina, CA 91790-3940
Mailing address
13327 Mesa Bluff CT
Chino Hills, CA 91709-3535
Phone (909) 591-1650
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA11411 | Medicaid | CA |
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA11411 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468540800000",
"number": "1912954348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13327 MESA BLUFF CT",
"city": "CHINO HILLS",
"state": "CA",
"postal_code": "917093535",
"telephone_number": "909-591-1650"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1115 S SUNSET AVE",
"city": "WEST COVINA",
"state": "CA",
"postal_code": "917903940",
"telephone_number": "626-814-2434"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTINEZ",
"first_name": "RONALD",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-30",
"last_updated": "2016-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA11411",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PA11411",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Covina, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.