MEDICARE: MRS. DOMINIQUE NICOLE MARTINEZ PMHNP-BC

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	86109	NM

General Provider Information

NPI Number	:	1528932431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DOMINIQUE NICOLE MARTINEZ PMHNP-BC

Provider Business Mailing Address
First Line	:	18 GALLEGOS RD
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4512
Country	:	US
Telephone Number	:	505-476-8769
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 GALLEGOS RD
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4512
Country	:	US
Telephone Number	:	505-476-8769
Fax Number	:

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

Provider Enumeration Date	:	10/02/2025
Last Update Date	:	10/02/2025

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