Individual
MARTIN ALAN FENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CCSS
Contact information
Practice address
801 N CALIFORNIA ST, SOCORRO, NM 87801-4254
(575) 835-8991
Mailing address
801 N CALIFORNIA ST, SOCORRO, NM 87801-4254
(575) 835-8991
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
NM
Other
Enumeration date
05/07/2024
Last updated
05/07/2024
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