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General NPI Number Information
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NPI Number | 1720587058
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Entity Type | Individual
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Provider Name | MANUEL A. MARTINEZ III LMSW
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Gender | Male
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Dates
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Enumeration Date | 02/01/2018
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Last Update Date | 03/20/2019
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Provider Practice Location Address
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Address Line | 3082 32ND STREET BYP
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City | SILVER CITY
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State | NM
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Zip | 88061
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Country | US
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Telephone | 575-538-2061
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Fax | 575-538-5742
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Provider Business Mailing Address
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Address Line | 700 N BULLARD ST
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City | SILVER CITY
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State | NM
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Zip | 88061-5413
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Country | US
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Telephone |
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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-10105
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License Number State | NM
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