Provider Demographics
NPI:1760280002
Name:MARTINEZ, MONICA AMY
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:AMY
Last Name:MARTINEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 RIM VIEW RD
Mailing Address - Street 2:
Mailing Address - City:RANCHOS DE TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87557
Mailing Address - Country:US
Mailing Address - Phone:505-633-0733
Mailing Address - Fax:505-472-8122
Practice Address - Street 1:31 RIM VIEW RD
Practice Address - Street 2:
Practice Address - City:RANCHOS DE TAOS
Practice Address - State:NM
Practice Address - Zip Code:87557
Practice Address - Country:US
Practice Address - Phone:505-633-0733
Practice Address - Fax:505-472-8122
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker