MEDICARE: DOMINIQUE MARTINEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MI4722	NV

General Provider Information

NPI Number	:	1013718428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIQUE MARTINEZ

Provider Business Mailing Address
First Line	:	2620 REGATTA DR STE 102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-6892
Country	:	US
Telephone Number	:	725-222-0303
Fax Number	:

Provider Business Practice Location Address
First Line	:	2620 REGATTA DR STE SUITE102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-6891
Country	:	US
Telephone Number	:	725-222-0303
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2025
Last Update Date	:	06/06/2026

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Directions to “ DOMINIQUE MARTINEZ ” Practice Location

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