MEDICARE: ERIC OMAR MARTINEZ RODRIGUEZ

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	163W00000X	Registered Nurse	1821	PR
2	390200000X	Student in an Organized Health Care Education/Training Program	1821	PR

General Provider Information

NPI Number	:	1720820061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC OMAR MARTINEZ RODRIGUEZ

Provider Business Mailing Address
First Line	:	6359 COLUMBUS BLVD
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33872-1797
Country	:	US
Telephone Number	:	787-315-1434
Fax Number	:

Provider Business Practice Location Address
First Line	:	6359 COLUMBUS BLVD
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33872-1797
Country	:	US
Telephone Number	:	787-315-1434
Fax Number	:

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

Provider Enumeration Date	:	06/08/2024
Last Update Date	:	05/08/2026

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