Healthcare Provider Details

I. General information

NPI: 1942952742
Provider Name (Legal Business Name): CRUCITA MARIE RIOSECO-MARTINEZ MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CRUCITA MARIE GONZALEZ MSN

II. Dates (important events)

Enumeration Date: 01/22/2022
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6148 PARADISE POINT DR
PALMETTO BAY FL
33157-2643
US

IV. Provider business mailing address

6148 PARADISE POINT DR
PALMETTO BAY FL
33157-2643
US

V. Phone/Fax

Practice location:
  • Phone: 786-218-5605
  • Fax:
Mailing address:
  • Phone: 786-218-5605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2846032
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN2846032
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code364SC2300X
TaxonomyChronic Care Clinical Nurse Specialist
License NumberRN2846032
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: