Healthcare Provider Details

I. General information

NPI: 1457171019
Provider Name (Legal Business Name): MS. GABRIELLE MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 06/06/2025
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 WELLSPRING AVE SE SUITE D, RIO RANCHO NM 87124
RIO RANCHO NM
87124
US

IV. Provider business mailing address

8100 WYOMING BLVD NE #406 M-, ALBUQUERQUE, NM 87113
ALBUQUERQUE NM
87113
US

V. Phone/Fax

Practice location:
  • Phone: 505-828-3837
  • Fax: 877-828-1550
Mailing address:
  • Phone: 505-715-4610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: