Active NPI
Nissa Martinez
- Counselor
- Bernalillo, NM
National Provider Identifier
1144357708
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 0113901
- Practice address
- 872 S Camino del Pueblo
Bernalillo, NM 87004-5927 - Phone
- (505) 867-2383
- Fax
- (505) 867-7293
- NPI assigned
- Feb 28, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 0113901 | NM | Primary |
Addresses
Primary practice location
872 S Camino del Pueblo
Bernalillo, NM 87004-5927
Mailing address
1027 Emmason Rd SW
Albuquerque, NM 87105-3923
Phone (505) 867-2383
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 47322373 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0113901 | NM | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| La Buena Vida, Inc. | Past | Accepting new patients | |
| Valle del Sol of New Mexico, LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Bernalillo, NM
- NPI 1386676856
-
- Community/Behavioral Health Agency
- Bernalillo, NM
- NPI 1649610171
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212105600000",
"number": "1144357708",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1027 EMMASON RD SW",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871053923",
"telephone_number": "505-867-2383",
"fax_number": "505-867-7293"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "872 S CAMINO DEL PUEBLO",
"city": "BERNALILLO",
"state": "NM",
"postal_code": "870045927",
"telephone_number": "505-867-2383",
"fax_number": "505-867-7293"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTINEZ",
"first_name": "NISSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-28",
"last_updated": "2008-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NM",
"license": "0113901",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47322373",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bernalillo, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.