Healthcare Provider Details

I. General information

NPI: 1366258352
Provider Name (Legal Business Name): ABRAHAM MARTINEZ NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ABRAHAM MARTINEZ NP

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 N TELSHOR BLVD STE A
LAS CRUCES NM
88011-8234
US

IV. Provider business mailing address

532 N TELSHOR BLVD STE A
LAS CRUCES NM
88011-8234
US

V. Phone/Fax

Practice location:
  • Phone: 575-224-6070
  • Fax: 575-224-6910
Mailing address:
  • Phone: 575-224-6070
  • Fax: 575-224-6910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number84626
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: