Provider Demographics
NPI:1710402722
Name:ORTIZ MARTINEZ, EDUARDO JOSE
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:JOSE
Last Name:ORTIZ 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 1:2740 S JONES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5306
Mailing Address - Country:US
Mailing Address - Phone:702-248-8866
Mailing Address - Fax:702-248-1339
Practice Address - Street 1:2740 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5306
Practice Address - Country:US
Practice Address - Phone:702-248-8866
Practice Address - Fax:702-248-1339
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor