Healthcare Provider Details

I. General information

NPI: 1538516257
Provider Name (Legal Business Name): ROSALIA MARTINEZ PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 SANTA BARBARA BLVD
CAPE CORAL FL
33991-2031
US

IV. Provider business mailing address

1834 SW 17TH PL
CAPE CORAL FL
33991-3110
US

V. Phone/Fax

Practice location:
  • Phone: 239-573-9693
  • Fax: 239-573-9694
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberPTA25733
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: