Provider Demographics
NPI:1366508947
Name:JORGE A. MARTINEZ, M.D.
Entity type:Organization
Organization Name:JORGE A. MARTINEZ, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP
Authorized Official - Phone:951-461-1331
Mailing Address - Street 1:39755 MURRIETA HOT SPRINGS RD
Mailing Address - Street 2:SUITE E-120
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-9101
Mailing Address - Country:US
Mailing Address - Phone:951-461-1331
Mailing Address - Fax:951-461-1307
Practice Address - Street 1:39755 MURRIETA HOT SPRINGS RD
Practice Address - Street 2:SUITE E-120
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-9101
Practice Address - Country:US
Practice Address - Phone:951-461-1331
Practice Address - Fax:951-461-1307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49113261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE52442Medicare UPIN