Provider Demographics
NPI:1073695615
Name:MARTINEZ, RUPERTO RICARDO (PHD)
Entity Type:Individual
Prefix:DR
First Name:RUPERTO
Middle Name:RICARDO
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 VISTA DE LUZ DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1907
Mailing Address - Country:US
Mailing Address - Phone:505-899-2620
Mailing Address - Fax:505-897-2199
Practice Address - Street 1:5120 VISTA DE LUZ DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1907
Practice Address - Country:US
Practice Address - Phone:505-899-2620
Practice Address - Fax:505-897-2199
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM426103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00NM00L240OtherBLUE CROSS-BLUE SHIELD
NM20089OtherPRESBYTERIANHEALTH PLAN
NM00NM00L240OtherBLUE CROSS-BLUE SHIELD