Provider Demographics
NPI:1831557248
Name:MARTINEZ, NATHALIE (CRIMINAL JUSTICE)
Entity type:Individual
Prefix:MISS
First Name:NATHALIE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CRIMINAL JUSTICE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4917 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-2603
Mailing Address - Country:US
Mailing Address - Phone:702-862-9074
Mailing Address - Fax:702-369-3334
Practice Address - Street 1:1455 E TROPICANA AVE
Practice Address - Street 2:SUITE 175B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6507
Practice Address - Country:US
Practice Address - Phone:702-893-2002
Practice Address - Fax:702-369-3334
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV2014064283Medicaid