Provider Demographics
NPI:1598358160
Name:MARTINEZ FERNANDEZ, ROSY LUZ
Entity type:Individual
Prefix:
First Name:ROSY
Middle Name:LUZ
Last Name:MARTINEZ FERNANDEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9371 FONTAINEBLEAU BLVD APT I121
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5672
Mailing Address - Country:US
Mailing Address - Phone:786-278-1181
Mailing Address - Fax:
Practice Address - Street 1:9371 FONTAINEBLEAU BLVD APT I121
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-5672
Practice Address - Country:US
Practice Address - Phone:786-278-1181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11011558363LF0000X
FLAPRN11011558363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily