MEDICARE: CYNTHIA LIZETTE MARTINEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	75161	TX

General Provider Information

NPI Number	:	1467118091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA LIZETTE MARTINEZ

Provider Business Mailing Address
First Line	:	500 CORTEZ DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79905-5104
Country	:	US
Telephone Number	:	915-799-4176
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 CORTEZ DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79905-5104
Country	:	US
Telephone Number	:	915-799-4176
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2021
Last Update Date	:	11/09/2021

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Directions to “ CYNTHIA LIZETTE MARTINEZ ” Practice Location

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