Provider Demographics
NPI:1104167584
Name:MARTINEZ CREATIVE PRODUCTIONS
Entity type:Organization
Organization Name:MARTINEZ CREATIVE PRODUCTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:YOUTH COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:702-360-4669
Mailing Address - Street 1:7316 SAYBROOK POINT DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-3205
Mailing Address - Country:US
Mailing Address - Phone:702-360-4669
Mailing Address - Fax:
Practice Address - Street 1:7316 SAYBROOK POINT DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-3205
Practice Address - Country:US
Practice Address - Phone:702-360-4669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB20-00667-J-112759101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty