Provider Demographics
NPI:1245758465
Name:MARTINEZ, RODOLFO GABRIEL (LMSW)
Entity Type:Individual
Prefix:MR
First Name:RODOLFO
Middle Name:GABRIEL
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 DESIERTO RICO AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-8437
Mailing Address - Country:US
Mailing Address - Phone:575-621-5960
Mailing Address - Fax:
Practice Address - Street 1:125 W MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-1826
Practice Address - Country:US
Practice Address - Phone:575-449-4731
Practice Address - Fax:575-288-1356
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-08285104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker