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NPI Code Detail

MEDICARE: MIRANDA ADELITA MARTINEZ

MEDICARE: MIRANDA ADELITA 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1710560701
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRANDA ADELITA MARTINEZ
Provider Business Mailing Address
First Line : RR 4 BOX 5B
Second Line :
City : HERNANDEZ
State : NM
Zip : 87537-9706
Country : US
Telephone Number : 505-423-0648
Fax Number :
Provider Business Practice Location Address
First Line : 1201 PARKWAY DR # B
Second Line :
City : SANTA FE
State : NM
Zip : 87507-7258
Country : US
Telephone Number : 505-508-0865
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2021
Last Update Date : 04/28/2021

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Directions to “ MIRANDA ADELITA MARTINEZ ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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