Healthcare Provider Details

I. General information

NPI: 1245758465
Provider Name (Legal Business Name): RODOLFO GABRIEL MARTINEZ LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 09/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W MOUNTAIN AVE
LAS CRUCES NM
88005-1826
US

IV. Provider business mailing address

1529 DESIERTO RICO AVE
EL PASO TX
79912-8437
US

V. Phone/Fax

Practice location:
  • Phone: 575-449-4731
  • Fax: 575-288-1356
Mailing address:
  • Phone: 575-621-5960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-08285
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: