| Doctor Name: | MISS LORI LOUISE MARTIN |
| NPI Number: | 1538159298 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PAC |
| License Number: | PA15787 |
| Business Practice Address: | 576 Jefferson Ave Primary Care Clinic Rm 330 Fort Eustis, VA - 236041602 |
| Business Phone Number: | 7573147613 |
| Business Fax Number: | |
| Mailing Address: | 797 S Fair Oaks Ave, PASADENA |
| State: | CA |
| Postal Code: | 911052617 |
| Phone Number: | 3106216439 |
| Fax Number: | |
| NPI Enumeration Date: | 10/25/2005 |
| NPI Last Update Date: | 05/29/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA15787 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |