Healthcare Provider Details

I. General information

NPI: 1669984118
Provider Name (Legal Business Name): ROSI MARTINEZ LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 WAYNE AVE
DAYTON OH
45410-1122
US

IV. Provider business mailing address

600 WAYNE AVE
DAYTON OH
45410-1122
US

V. Phone/Fax

Practice location:
  • Phone: 614-409-1400
  • Fax: 614-754-5135
Mailing address:
  • Phone: 614-409-1400
  • Fax: 614-754-5135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number154540
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: