Individual
MR. RONALD MARTINEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
550 OAKLAWN AVE, EAST MOLINE, IL 61244-4030
(309) 792-1074
Mailing address
550 OAKLAWN AVE, EAST MOLINE, IL 61244
(309) 792-1074
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08132008
BLUE CROSS BLUE SHIELD IL
IL
Enumeration date
12/21/2006
Last updated
07/08/2007
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