Provider Demographics
NPI:1326732611
Name:CAMPOS MARTINEZ, ROSA IIVIA
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:IIVIA
Last Name:CAMPOS 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 1:2436 SW 7TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-3023
Mailing Address - Country:US
Mailing Address - Phone:786-870-3409
Mailing Address - Fax:
Practice Address - Street 1:2436 SW 7TH ST APT 4
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-3023
Practice Address - Country:US
Practice Address - Phone:786-870-3409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL110243209363LF0000X
FL11024329363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily