Provider Demographics
NPI:1831848738
Name:ROSA MARTELL, GRACE M (DC)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:M
Last Name:ROSA MARTELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 10680
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-6428
Mailing Address - Country:US
Mailing Address - Phone:787-222-3972
Mailing Address - Fax:
Practice Address - Street 1:URB VICTORIA HEIGHTS B-4 CALLE 3
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-1931
Practice Address - Country:US
Practice Address - Phone:787-222-3972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-20
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor