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General NPI Number Information
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NPI Number | 1497880744
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Entity Type | Individual
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Provider Name | RUDOLPH ALBERT MARTINEZ MSW
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Gender | Male
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 2560 BUSINESS PKWY
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City | MINDEN
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State | NV
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Zip | 89423-8985
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Country | US
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Telephone | 775-267-9411
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 267
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City | BRIDGEPORT
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State | CA
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Zip | 93517-0267
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Country | US
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Telephone | 626-641-8282
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 104271
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License Number State | CA
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