Provider Demographics
NPI:1497880744
Name:MARTINEZ, RUDOLPH ALBERT (MSW)
Entity type:Individual
Prefix:MR
First Name:RUDOLPH
Middle Name:ALBERT
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:MR
Other - First Name:RUDY
Other - Middle Name:ALBERT
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:93517-0267
Mailing Address - Country:US
Mailing Address - Phone:626-641-8282
Mailing Address - Fax:
Practice Address - Street 1:2560 BUSINESS PKWY
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-8985
Practice Address - Country:US
Practice Address - Phone:775-267-9411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
CA104271104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner