Provider Demographics
NPI:1114542784
Name:MARTINEZ RODRIGUEZ, KEISHLA M
Entity Type:Individual
Prefix:DR
First Name:KEISHLA
Middle Name:M
Last Name:MARTINEZ RODRIGUEZ
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 1:500 CALLE MODESTA APT 1403
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-4182
Mailing Address - Country:US
Mailing Address - Phone:787-646-4324
Mailing Address - Fax:
Practice Address - Street 1:500 CALLE MODESTA APT 1403
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-4182
Practice Address - Country:US
Practice Address - Phone:787-646-4324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR719111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor