Healthcare Provider Details

I. General information

NPI: 1063762318
Provider Name (Legal Business Name): MARTHA MELO CROSS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9395 SW 130TH ST
MIAMI FL
33176-5763
US

IV. Provider business mailing address

9395 SW 130TH ST
MIAMI FL
33176-5763
US

V. Phone/Fax

Practice location:
  • Phone: 305-338-6781
  • Fax: 305-232-2396
Mailing address:
  • Phone: 305-338-6781
  • Fax: 305-232-2396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1951992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: