Provider Demographics
NPI:1598368474
Name:MARTINEZ, ROSALIA MARIA (LMT, MMP)
Entity Type:Individual
Prefix:
First Name:ROSALIA
Middle Name:MARIA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13007 S 40TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-3906
Mailing Address - Country:US
Mailing Address - Phone:480-658-8274
Mailing Address - Fax:
Practice Address - Street 1:8400 S KYRENE RD STE 115
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-2119
Practice Address - Country:US
Practice Address - Phone:480-658-8274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-18964225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMT-18964OtherMASSAGE LICENSE