MEDICARE: SELBA VIRGEN MARTINEZ RRT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2279H0200X	Home Health Registered Respiratory Therapist

General Provider Information

NPI Number	:	1699112656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELBA VIRGEN MARTINEZ RRT

Provider Business Mailing Address
First Line	:	6238 GRANT ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-5941
Country	:	US
Telephone Number	:	954-240-5155
Fax Number	:

Provider Business Practice Location Address
First Line	:	6238 GRANT ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-5941
Country	:	US
Telephone Number	:	954-240-5155
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2013
Last Update Date	:	05/31/2013

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