Healthcare Provider Details

I. General information

NPI: 1215410121
Provider Name (Legal Business Name): ROSARIO MARITNEZ MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 GARDENDALE STE. A-201
SAN ANTONIO TN
78229
US

IV. Provider business mailing address

14745 BABCOCK RD #503
SAN ANTONIO TX
78249
US

V. Phone/Fax

Practice location:
  • Phone: 210-644-4434
  • Fax: 210-644-4407
Mailing address:
  • Phone: 210-262-7952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number213333
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: