Healthcare Provider Details

I. General information

NPI: 1497880744
Provider Name (Legal Business Name): RUDOLPH ALBERT MARTINEZ MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RUDY ALBERT MARTINEZ MSW

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 BUSINESS PKWY
MINDEN NV
89423-8985
US

IV. Provider business mailing address

PO BOX 267
BRIDGEPORT CA
93517-0267
US

V. Phone/Fax

Practice location:
  • Phone: 775-267-9411
  • Fax:
Mailing address:
  • Phone: 626-641-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number104271
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: