Doctor Name: | MARK MARTINEZ |
NPI Number: | 1518291558 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LADAC |
License Number: | 006263 |
Business Practice Address: | 101 'd' Avenue Black Rock Zuni, NM - 873270101 |
Business Phone Number: | 5057824710 |
Business Fax Number: | 5057825880 |
Mailing Address: | Po Box 339, C/o Zuni Recovery Center ZUNI |
State: | NM |
Postal Code: | 873270339 |
Phone Number: | 5057824710 |
Fax Number: | 5057825880 |
NPI Enumeration Date: | 09/23/2009 |
NPI Last Update Date: | 09/23/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 006263 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |