Provider Demographics
NPI:1659099471
Name:MARTIN, ALFONSO (CTSS)
Entity Type:Individual
Prefix:
First Name:ALFONSO
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:CTSS
Other - Prefix:
Other - First Name:ALFONSO
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CTSS
Mailing Address - Street 1:2197 S 4TH AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6473
Mailing Address - Country:US
Mailing Address - Phone:928-920-6220
Mailing Address - Fax:928-259-7272
Practice Address - Street 1:2197 S 4TH AVE STE 202
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6473
Practice Address - Country:US
Practice Address - Phone:928-920-6220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator