Provider Demographics
NPI:1821643107
Name:LIU, RUTONG MARTINEZ (PSYD)
Entity type:Individual
Prefix:
First Name:RUTONG
Middle Name:MARTINEZ
Last Name:LIU
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:JUSTIN
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:6521 HOOP ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-2565
Mailing Address - Country:US
Mailing Address - Phone:915-313-2772
Mailing Address - Fax:
Practice Address - Street 1:350 REVERE ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-1633
Practice Address - Country:US
Practice Address - Phone:915-564-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2025-05-20
Deactivation Date:2024-12-31
Deactivation Code:
Reactivation Date:2025-05-09
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX40375103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program