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General NPI Number Information
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NPI Number | 1245472067
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Entity Type | Individual
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Provider Name | LYNETTE MARTINEZ LADAC
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Gender | Female
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Dates
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Enumeration Date | 03/25/2009
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Last Update Date | 11/12/2021
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Provider Practice Location Address
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Address Line | 101 D AVENUE
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City | ZUNI
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State | NM
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Zip | 87327
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Country | US
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Telephone | 505-782-4710
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Fax | 505-782-5880
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Provider Business Mailing Address
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Address Line | PO BOX 339
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City | ZUNI
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State | NM
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Zip | 87327-0339
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Country | US
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Telephone | 505-782-4710
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Fax | 505-782-5580
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0121301
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License Number State | NM
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