Healthcare Provider Details

I. General information

NPI: 1619511672
Provider Name (Legal Business Name): MARIEM RODRIGUEZ MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2019
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SW 84TH AVE APT 317
MIAMI FL
33144-4162
US

IV. Provider business mailing address

900 SW 84TH AVE APT 317
MIAMI FL
33144-4162
US

V. Phone/Fax

Practice location:
  • Phone: 786-419-3703
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0042009
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11001226
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP035581
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberGAA-NP004049
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: