Individual
MR. ROGER DANIEL MARTINEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADAC
Contact information
Practice address
413 SIPAPU, TAOS, NM 87571-6489
(505) 758-5857
(505) 758-2832
Mailing address
PO BOX 33073, SANTA FE, NM 87594-3073
(505) 758-7629
(505) 758-7629
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
4956
NM
Other
Enumeration date
05/17/2007
Last updated
07/08/2007
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