Provider Demographics
NPI:1114523438
Name:MARTINEZ, HERBERTH ALBERTO
Entity Type:Individual
Prefix:
First Name:HERBERTH
Middle Name:ALBERTO
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 1:5855 W HAMPDEN AVE UNIT 4404
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80227-5345
Mailing Address - Country:US
Mailing Address - Phone:720-451-5114
Mailing Address - Fax:
Practice Address - Street 1:2500 ARAPAHOE AVE STE 230
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-6752
Practice Address - Country:US
Practice Address - Phone:720-432-4326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician