Healthcare Provider Details

I. General information

NPI: 1841661535
Provider Name (Legal Business Name): CHRISTOPHER J MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6704 NUEVA PIEDRA ST NW
ALBUQUERQUE NM
87120-3618
US

IV. Provider business mailing address

6704 NUEVA PIEDRA ST NW
ALBUQUERQUE NM
87120-3618
US

V. Phone/Fax

Practice location:
  • Phone: 505-249-3826
  • Fax:
Mailing address:
  • Phone: 505-249-3826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: