Healthcare Provider Details

I. General information

NPI: 1336592559
Provider Name (Legal Business Name): ROSA A MARTINEZ CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12360 E BURNSIDE ST
PORTLAND OR
97233-1042
US

IV. Provider business mailing address

1776 SW MADISON ST
PORTLAND OR
97205-1715
US

V. Phone/Fax

Practice location:
  • Phone: 971-279-4800
  • Fax: 971-279-2763
Mailing address:
  • Phone: 503-224-1044
  • Fax: 503-621-2235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberCPT-0001956
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: