MEDICARE: JAMIE FAY MARTINEZ LMSW

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	104100000X	Social Worker	M-10198	NM

General Provider Information

NPI Number	:	1902473663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE FAY MARTINEZ LMSW

Provider Business Mailing Address
First Line	:	PO BOX 45681
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87174-5681
Country	:	US
Telephone Number	:	505-426-5451
Fax Number	:

Provider Business Practice Location Address
First Line	:	2417 JESSIE LEE LN
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-5026
Country	:	US
Telephone Number	:	505-426-5451
Fax Number	:

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

Provider Enumeration Date	:	06/09/2021
Last Update Date	:	06/09/2021

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