Provider Demographics
NPI:1013213354
Name:MARTIN, DANIEL KEITH X (BACHLORS OF SCIENCE)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:KEITH
Last Name:MARTIN
Suffix:X
Gender:M
Credentials:BACHLORS OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11912 AMISTOSO LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-4532
Mailing Address - Country:US
Mailing Address - Phone:702-716-4301
Mailing Address - Fax:
Practice Address - Street 1:11912 AMISTOSO LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89138-4532
Practice Address - Country:US
Practice Address - Phone:702-716-4301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVABCMARTIN2Medicaid