Provider Demographics
NPI:1437598018
Name:MARTINEZ, MANUEL ABRAHAM
Entity Type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:ABRAHAM
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 1:1747 HOWARD CT
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-3404
Mailing Address - Country:US
Mailing Address - Phone:775-848-9019
Mailing Address - Fax:
Practice Address - Street 1:3225 MCLEOD DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-2257
Practice Address - Country:US
Practice Address - Phone:702-871-8535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst