Provider Demographics
NPI:1568620227
Name:MARTIN, MARIA ROCHELLE CARREON (MD)
Entity Type:Individual
Prefix:
First Name:MARIA ROCHELLE
Middle Name:CARREON
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA ROCHELLE
Other - Middle Name:CARREON
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9230 SKY ISLAND DR E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-7385
Mailing Address - Country:US
Mailing Address - Phone:253-750-6000
Mailing Address - Fax:253-750-6100
Practice Address - Street 1:9230 SKY ISLAND DR E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-7385
Practice Address - Country:US
Practice Address - Phone:253-750-6000
Practice Address - Fax:253-750-6100
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08438100207Q00000X
MI4301091747207Q00000X
WAMD60120795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2005491Medicaid