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General NPI Number Information
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NPI Number | 1407246382
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Entity Type | Individual
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Provider Name | ROGER GERARDO MARTINEZ BSW
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Gender | Male
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Dates
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Enumeration Date | 01/29/2015
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Last Update Date | 01/29/2015
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Provider Practice Location Address
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Address Line | 875 WAIMANU ST STE 624
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City | HONOLULU
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State | HI
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Zip | 96813-5265
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Country | US
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Telephone | 808-791-6613
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Fax |
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Provider Business Mailing Address
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Address Line | 98-660 MOANALUA LOOP APT 180
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City | AIEA
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State | HI
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Zip | 96701-5152
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Country | US
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Telephone | 808-954-0329
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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