Doctor Name: | ISAAC MARTINEZ |
NPI Number: | 1043569650 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 8745 County Road 9 S Alamosa, CO - 811019610 |
Business Phone Number: | 7195875624 |
Business Fax Number: | 7195899136 |
Mailing Address: | 8745 County Road 9 S, ALAMOSA |
State: | CO |
Postal Code: | 811019610 |
Phone Number: | 7195875624 |
Fax Number: | 7195899136 |
NPI Enumeration Date: | 08/29/2012 |
NPI Last Update Date: | 08/29/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |