Provider Demographics
NPI:1881203347
Name:MARTINEZ, VERONICA TELESFORA
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:TELESFORA
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 1:7220 CENTRAL AVE SE APT 1154
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2076
Mailing Address - Country:US
Mailing Address - Phone:505-485-2023
Mailing Address - Fax:
Practice Address - Street 1:7220 CENTRAL AVE SE APT 1154
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2076
Practice Address - Country:US
Practice Address - Phone:505-485-2023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician