Provider Demographics
NPI:1972266559
Name:MARTINEZ, JUDE ROLAND
Entity Type:Individual
Prefix:
First Name:JUDE
Middle Name:ROLAND
Last Name: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 1:15 WALNUT CIR
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-8081
Mailing Address - Country:US
Mailing Address - Phone:505-423-5810
Mailing Address - Fax:
Practice Address - Street 1:15 WALNUT CIR
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-8081
Practice Address - Country:US
Practice Address - Phone:505-423-5810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician