Provider Demographics
NPI:1942952742
Name:RIOSECO-MARTINEZ, CRUCITA MARIE (MSN)
Entity Type:Individual
Prefix:
First Name:CRUCITA
Middle Name:MARIE
Last Name:RIOSECO-MARTINEZ
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:CRUCITA
Other - Middle Name:MARIE
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN
Mailing Address - Street 1:6148 PARADISE POINT DR
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-2643
Mailing Address - Country:US
Mailing Address - Phone:786-218-5605
Mailing Address - Fax:
Practice Address - Street 1:6148 PARADISE POINT DR
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-2643
Practice Address - Country:US
Practice Address - Phone:786-218-5605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-22
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2846032163W00000X
FLRN2846032364SP0809X, 364SC2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC2300XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistChronic Care
No163W00000XNursing Service ProvidersRegistered Nurse
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult