Individual
DR. MARIO ENRIQUE MARTINEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
4525 HARDING RD, NASHVILLE, TN 37205-2119
(615) 736-5654
Mailing address
4525 HARDING RD., NASHVILLE, TN 37205
(615) 736-5654
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
P693
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
621390152
FEDERAL TAX ID
TN
Enumeration date
10/24/2008
Last updated
10/24/2008
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