Individual
DESIREE DAWN MARTINEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSAA
Contact information
Practice address
1227 N RAILROAD AVE STE C, ESPANOLA, NM 87532-3159
(505) 747-8187
(505) 747-8306
Mailing address
PO BOX 1725, SANTA CRUZ, NM 87567-1725
(505) 927-9220
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CTB-2022-0753
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CTB-2022-0753
—
NM
Enumeration date
10/13/2022
Last updated
10/13/2022
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