Doctor Name: | BOBBY MARTINEZ |
NPI Number: | 1336260108 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 243 White Mt. Dr. Mescalero, NM - 88340 |
Business Phone Number: | 5059377422 |
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Mailing Address: | Po Box 122, GLENCOE |
State: | NM |
Postal Code: | 883240122 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 04/02/2007 |
NPI Last Update Date: | 07/08/2007 |
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: |