Provider Demographics
NPI:1629302724
Name:MARTINEZ, VALERIE RIVERA
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:RIVERA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 E FAIRVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532
Mailing Address - Country:US
Mailing Address - Phone:505-747-1991
Mailing Address - Fax:505-753-6462
Practice Address - Street 1:904 E FAIRVIEW LN
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2822
Practice Address - Country:US
Practice Address - Phone:505-747-1991
Practice Address - Fax:505-753-6462
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator