Individual
RYAN MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSAA
Contact information
Practice address
15A BAY POE, SANTA FE, NM 87506-2731
(505) 455-5591
Mailing address
15A BAY POE, SANTA FE, NM 87506-2731
(505) 455-5591
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CSA0209611
NM
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
503091488
—
NM
Enumeration date
06/11/2015
Last updated
08/13/2025
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