Healthcare Provider Details

I. General information

NPI: 1841863008
Provider Name (Legal Business Name): ANGELO DAMIAN MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 GOLF COURSE RD SE STE 203
RIO RANCHO NM
87124-4731
US

IV. Provider business mailing address

1101 GOLF COURSE RD SE STE 203
RIO RANCHO NM
87124-4731
US

V. Phone/Fax

Practice location:
  • Phone: 505-518-5757
  • Fax: 505-461-6217
Mailing address:
  • Phone: 505-518-5757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB20250584
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: