Basic Information
| Provider Information | |||||||||
| NPI: | 1821326513 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | ISMAEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 262 | ||||||||
| Address2: | |||||||||
| City: | COTULLA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780140262 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 304 NUECES | ||||||||
| Address2: | |||||||||
| City: | COTULLA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780142237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8308793048 | ||||||||
| FaxNumber: | 8308796390 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2009 | ||||||||
| LastUpdateDate: | 11/18/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.