Individual
MANUEL ROMAN MARTINEZ I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CAC 1
Contact information
Practice address
720 N MAIN ST STE 240, PUEBLO, CO 81003-3046
(719) 569-7909
Mailing address
1611 GLENWOOD LN, PUEBLO, CO 81005-2213
(719) 248-9629
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0007634
CO
Other
Enumeration date
04/25/2018
Last updated
04/25/2018
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