Provider Demographics
NPI:1871729483
Name:MARTINEZ, DARYL DEAN SANDOVAL (MD)
Entity type:Individual
Prefix:DR
First Name:DARYL DEAN
Middle Name:SANDOVAL
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DARYL
Other - Middle Name:SANDOVAL
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2299 BACON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2045
Mailing Address - Country:US
Mailing Address - Phone:925-676-2942
Mailing Address - Fax:925-676-7108
Practice Address - Street 1:2299 BACON ST STE 2
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2045
Practice Address - Country:US
Practice Address - Phone:925-676-2942
Practice Address - Fax:925-676-7108
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111891207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXDP237A63245OtherBLUE CROSS PPO
CAXDP237A63245OtherBLUE CROSS PPO