Provider Demographics
NPI:1447949532
Name:REMARK MARTINEZ, DOROTHEA GUADALUPE
Entity type:Individual
Prefix:
First Name:DOROTHEA
Middle Name:GUADALUPE
Last Name:REMARK MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GUADALUPE
Other - Middle Name:
Other - Last Name:REMARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14726 RAMONA AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5730
Mailing Address - Country:US
Mailing Address - Phone:626-305-9100
Mailing Address - Fax:626-305-0152
Practice Address - Street 1:1120 W WASHINGTON BLVD FL 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3316
Practice Address - Country:US
Practice Address - Phone:213-789-5030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35470152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist