Provider Demographics
NPI:1164133963
Name:MARTINEZ, DEYON ELIJAH (BEHAVIOR TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:DEYON
Middle Name:ELIJAH
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 MANZANARES AVE E
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-4218
Mailing Address - Country:US
Mailing Address - Phone:575-517-5579
Mailing Address - Fax:
Practice Address - Street 1:506 MANZANARES AVE E
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-4218
Practice Address - Country:US
Practice Address - Phone:575-517-5579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician