MEDICARE: EVELYN 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1932661832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELYN MARTINEZ

Provider Business Mailing Address
First Line	:	3400 MENAUL BLVD NE STE 200
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-1818
Country	:	US
Telephone Number	:	505-302-5383
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 MENAUL BLVD NE # 200
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-1818
Country	:	US
Telephone Number	:	505-302-5383
Fax Number	:

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

Provider Enumeration Date	:	04/01/2019
Last Update Date	:	10/11/2023

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Directions to “ EVELYN MARTINEZ ” Practice Location

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