Provider Demographics
NPI:1033388467
Name:MARTINEZ, CARLOS VRIJIDO
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:VRIJIDO
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 1:3361 N ACADEMY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5103
Mailing Address - Country:US
Mailing Address - Phone:719-285-7466
Mailing Address - Fax:719-409-0482
Practice Address - Street 1:3361 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5103
Practice Address - Country:US
Practice Address - Phone:719-285-7466
Practice Address - Fax:719-409-0482
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW605809431041C0700X
KSLSCSW47731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical