Healthcare Provider Details

I. General information

NPI: 1730108317
Provider Name (Legal Business Name): RICKY MARTINEZ PHD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER CMR 402
APO GERMANY
AE
DE

IV. Provider business mailing address

4861 JONES DR
FORT GEORGE G MEADE MD
20755-2143
US

V. Phone/Fax

Practice location:
  • Phone: 496371868590
  • Fax:
Mailing address:
  • Phone: 410-940-9772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-3664
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: