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General NPI Number Information
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NPI Number | 1245758465
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Entity Type | Individual
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Provider Name | RODOLFO GABRIEL MARTINEZ LMSW
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Gender | Male
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Dates
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Enumeration Date | 09/08/2017
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Last Update Date | 09/08/2017
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Provider Practice Location Address
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Address Line | 125 W MOUNTAIN AVE
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City | LAS CRUCES
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State | NM
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Zip | 88005-1826
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Country | US
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Telephone | 575-449-4731
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Fax | 575-288-1356
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Provider Business Mailing Address
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Address Line | 1529 DESIERTO RICO AVE
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City | EL PASO
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State | TX
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Zip | 79912-8437
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Country | US
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Telephone | 575-621-5960
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | M-08285
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License Number State | NM
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