Provider Demographics
NPI:1225358203
Name:MARTINEZ-NAVARRO, MARIELLA (DC)
Entity Type:Individual
Prefix:DR
First Name:MARIELLA
Middle Name:
Last Name:MARTINEZ-NAVARRO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 N PONCE DE LEON BLVD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-2600
Mailing Address - Country:US
Mailing Address - Phone:787-360-0819
Mailing Address - Fax:
Practice Address - Street 1:125 MURRAY ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1311
Practice Address - Country:US
Practice Address - Phone:787-360-0819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012179-1111N00000X, 111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner