Provider Demographics
NPI:1336392968
Name:GUSTAVO MARTINEZ
Entity Type:Organization
Organization Name:GUSTAVO MARTINEZ
Other - Org Name:INTERVENTIONS INTERNATIONAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:915-241-7272
Mailing Address - Street 1:814 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79901-1512
Mailing Address - Country:US
Mailing Address - Phone:915-241-7272
Mailing Address - Fax:877-587-9452
Practice Address - Street 1:814 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79901-1512
Practice Address - Country:US
Practice Address - Phone:915-241-7272
Practice Address - Fax:877-587-9452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0056RYOtherBCBS
TX613809Medicare PIN