Provider Demographics
NPI:1215410121
Name:MARTINEZ, ROSARIO MARITNEZ
Entity Type:Individual
Prefix:
First Name:ROSARIO
Middle Name:MARITNEZ
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 1:14745 BABCOCK RD #503
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249
Mailing Address - Country:US
Mailing Address - Phone:210-262-7952
Mailing Address - Fax:
Practice Address - Street 1:4211 GARDENDALE STE. A-201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TN
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-644-4434
Practice Address - Fax:210-644-4407
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213333251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213333OtherTBOTE