Provider Demographics
NPI:1174746259
Name:MARTIN, ALEXIS A (MD)
Entity type:Individual
Prefix:MR
First Name:ALEXIS
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7080 HOLLYWOOD BLVD.
Mailing Address - Street 2:SUITE 804
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028
Mailing Address - Country:US
Mailing Address - Phone:323-285-5300
Mailing Address - Fax:323-463-4000
Practice Address - Street 1:7080 HOLLYWOOD BLVD.
Practice Address - Street 2:SUITE 804
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028
Practice Address - Country:US
Practice Address - Phone:323-285-5300
Practice Address - Fax:323-463-4000
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG24087174400000X
CAG24871207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist