Most Relevant Information
Provider Data
| NPI Number: | 1003207952 |
| Provider Name: | SHANYCOLE MARTINEZ BMS |
| Entity Type: | Individual |
| Taxonomy Code: | 101Y00000X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 02/13/2015 |
| Last Updated: | 06/26/2015 |
Provider Practice Location
501 S 4TH ST
SANTA ROSA
NM
884352417
Practice Location Phone/Fax
| Phone: | 5754720745 |
| Fax: |
Provider Mailing Location
2551 COORS BLVD NW
ALBUQUERQUE
NM
871201213
Provider Mailing Phone/Fax
| Phone: | 5053383320 |
| Fax: |