Provider Demographics
NPI:1467535237
Name:MARTINEZ, ROSA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2275
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-6607
Mailing Address - Country:US
Mailing Address - Phone:787-864-5233
Mailing Address - Fax:787-864-5233
Practice Address - Street 1:BO PUENTE JOBOS
Practice Address - Street 2:CARR #3 KM143.8
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-6607
Practice Address - Country:US
Practice Address - Phone:787-864-5233
Practice Address - Fax:787-864-5233
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11268261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG04599Medicare UPIN
PR0084474Medicare ID - Type Unspecified