Provider Demographics
NPI:1366705725
Name:MARTINEZ, ELI
Entity type:Individual
Prefix:
First Name:ELI
Middle Name:
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 1:3428 STEPPE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-7944
Mailing Address - Country:US
Mailing Address - Phone:702-428-7338
Mailing Address - Fax:702-428-7338
Practice Address - Street 1:3428 STEPPE ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-7944
Practice Address - Country:US
Practice Address - Phone:702-428-7338
Practice Address - Fax:702-428-7338
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor