Provider Demographics
NPI:1669831384
Name:MARTINEZ, JANETTE (CRIMINAL JUSTICE)
Entity Type:Individual
Prefix:MISS
First Name:JANETTE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CRIMINAL JUSTICE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 GLOBE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-0746
Mailing Address - Country:US
Mailing Address - Phone:775-419-7240
Mailing Address - Fax:702-369-3334
Practice Address - Street 1:1785 E SAHARA AVE STE 340
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3717
Practice Address - Country:US
Practice Address - Phone:702-433-0063
Practice Address - Fax:702-433-0593
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV2014064283Medicaid