MEDICARE: MRS. ROSMARY MARTINEZ LD/N

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	133N00000X	Nutritionist	ND7130	FL
2	133V00000X	Registered Dietitian	ND 7130	FL

General Provider Information

NPI Number	:	1710376991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROSMARY MARTINEZ LD/N

Provider Business Mailing Address
First Line	:	1825 FOREST HILL BLVD STE 103
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-6058
Country	:	US
Telephone Number	:	561-213-3275
Fax Number	:

Provider Business Practice Location Address
First Line	:	1825 FOREST HILL BLVD STE 103
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-6058
Country	:	US
Telephone Number	:	561-213-3275
Fax Number	:

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

Provider Enumeration Date	:	01/12/2015
Last Update Date	:	04/09/2015

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