Provider Demographics
NPI:1154641405
Name:MARTINEZ, ALLEN R (BMS COORDINATOR)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:R
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:BMS COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 DON FERNANDO ST
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-5953
Mailing Address - Country:US
Mailing Address - Phone:575-751-7037
Mailing Address - Fax:575-758-3459
Practice Address - Street 1:314 DON FERNANDO ST
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5953
Practice Address - Country:US
Practice Address - Phone:575-751-7037
Practice Address - Fax:575-758-3459
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NM171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor