Healthcare Provider Details

I. General information

NPI: 1154360360
Provider Name (Legal Business Name): CECILIA MONICA MARTINEZ M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 01/27/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87111-2577
US

IV. Provider business mailing address

9500 MONTGOMERY BLVD NE STE 215ERY
ALBUQUERQUE NM
87111-2504
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-4224
  • Fax:
Mailing address:
  • Phone: 505-247-4224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number395
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number395
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: