Provider Demographics
NPI:1043820202
Name:MARTINEZ, MARCO (RADT)
Entity Type:Individual
Prefix:MR
First Name:MARCO
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 BUCKMAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:CAMPO
Mailing Address - State:CA
Mailing Address - Zip Code:91906-2022
Mailing Address - Country:US
Mailing Address - Phone:619-478-5696
Mailing Address - Fax:619-478-2404
Practice Address - Street 1:1777 BUCKMAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:CAMPO
Practice Address - State:CA
Practice Address - Zip Code:91906-2022
Practice Address - Country:US
Practice Address - Phone:619-478-5696
Practice Address - Fax:619-478-2404
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1506860523101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)