MEDICARE: MONTEAL MARTIN

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	251S00000X	Community/Behavioral Health Agency	NVPY0416	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306269634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONTEAL MARTIN

Provider Business Mailing Address
First Line	:	3109 N MICHAEL WAY
Second Line	:	UNIT C
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4101
Country	:	US
Telephone Number	:	702-542-5296
Fax Number	:

Provider Business Practice Location Address
First Line	:	5546 CAMINO AL NORTE
Second Line	:	2-333
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-0805
Country	:	US
Telephone Number	:	702-910-3230
Fax Number	:

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

Provider Enumeration Date	:	01/22/2014
Last Update Date	:	01/22/2014

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Directions to “ MONTEAL MARTIN ” Practice Location

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