Provider Demographics
NPI:1033388467
Name:MARTINEZ, CARLOS VRIJIDO
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:VRIJIDO
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 POYNTZ AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-6355
Mailing Address - Country:US
Mailing Address - Phone:785-320-6616
Mailing Address - Fax:785-320-6667
Practice Address - Street 1:720 POYNTZ AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502
Practice Address - Country:US
Practice Address - Phone:785-320-6616
Practice Address - Fax:785-320-6667
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2018-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW605809431041C0700X
KSLSCSW47731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical