Provider Demographics
NPI:1205480571
Name:MARTINEZ, RACHEL WELTER (DAC)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:WELTER
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:DAC
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:SUZANNE
Other - Last Name:WELTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:204 PAWTUXET AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3919
Mailing Address - Country:US
Mailing Address - Phone:401-339-1227
Mailing Address - Fax:
Practice Address - Street 1:120 DUDLEY ST STE 103
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-2431
Practice Address - Country:US
Practice Address - Phone:401-272-8262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDA00487171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist