Provider Demographics
NPI:1437134855
Name:DEMARTINI, DAVID ROBERT (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ROBERT
Last Name:DEMARTINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 LA CASA VIA
Mailing Address - Street 2:STE 222
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3052
Mailing Address - Country:US
Mailing Address - Phone:925-947-0888
Mailing Address - Fax:925-947-4385
Practice Address - Street 1:122 LA CASA VIA
Practice Address - Street 2:STE 222
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3052
Practice Address - Country:US
Practice Address - Phone:925-947-0888
Practice Address - Fax:925-947-4385
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG390000207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G390000Medicaid
CA00G390001Medicaid
CA00G390001Medicare ID - Type Unspecified
A47665Medicare UPIN
CA00G390001Medicaid