MEDICARE: JOANN MARTINEZ CAC III

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	ACC0020799	CO

General Provider Information

NPI Number	:	1134525025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANN MARTINEZ CAC III

Provider Business Mailing Address
First Line	:	3854 W PRINCETON CIR
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80236-3111
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3854 W PRINCETON CIR
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80236-3111
Country	:	US
Telephone Number	:	303-789-9936
Fax Number	:

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

Provider Enumeration Date	:	11/05/2014
Last Update Date	:	11/05/2014

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