Provider Demographics
NPI:1699081075
Name:MARTINEZ, ROSE J
Entity type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:J
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 3711
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-9730
Mailing Address - Country:US
Mailing Address - Phone:787-709-0494
Mailing Address - Fax:787-844-4130
Practice Address - Street 1:HC 2 BOX 3711
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-9730
Practice Address - Country:US
Practice Address - Phone:787-709-0494
Practice Address - Fax:787-844-4130
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR101YA0400X
PR25255163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)