Provider Demographics
NPI:1942347091
Name:MARTINEZ, ROSEMARY (NP)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-2842
Mailing Address - Country:US
Mailing Address - Phone:909-889-1136
Mailing Address - Fax:951-346-3107
Practice Address - Street 1:407 E GILBERT ST STE 1
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-5325
Practice Address - Country:US
Practice Address - Phone:909-889-1136
Practice Address - Fax:951-346-3107
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 288487363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology