Healthcare Provider Details

I. General information

NPI: 1225358203
Provider Name (Legal Business Name): MARIELLA MARTINEZ-NAVARRO D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 MURRAY ST
AUBURN NY
13021-1311
US

IV. Provider business mailing address

2200 N PONCE DE LEON BLVD SUITE #1
ST AUGUSTINE FL
32084-2600
US

V. Phone/Fax

Practice location:
  • Phone: 787-360-0819
  • Fax:
Mailing address:
  • Phone: 787-360-0819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX012179-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberX012179-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: