1700060506 NPI number — MR. P ROBERT LEE MARTINEZ LPCMHC

Table of content: MR. P ROBERT LEE MARTINEZ LPCMHC (NPI 1700060506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700060506 NPI number — MR. P ROBERT LEE MARTINEZ LPCMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINEZ
Provider First Name:
P ROBERT
Provider Middle Name:
LEE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LPCMHC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARTINEZ
Provider Other First Name:
P ROBERT
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPCMHC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1700060506
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 578
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TESUQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87574-0578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-983-3029
Provider Business Mailing Address Fax Number:
505-983-3029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
05A CERRO DE PALOMAS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA FE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87506-0084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-983-3029
Provider Business Practice Location Address Fax Number:
505-983-3029
Provider Enumeration Date:
12/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  0033 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com