Provider Demographics
NPI:1780183061
Name:MARTINEZ, VANESSA ANN QUIMING
Entity Type:Individual
Prefix:
First Name:VANESSA ANN
Middle Name:QUIMING
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 1:1778 BLUE RIBBON DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142-0737
Mailing Address - Country:US
Mailing Address - Phone:702-472-2848
Mailing Address - Fax:
Practice Address - Street 1:2320 PASEO DEL PRADO STE B208
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4332
Practice Address - Country:US
Practice Address - Phone:702-685-0877
Practice Address - Fax:702-749-5922
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9952-M1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical