Provider Demographics
NPI:1134642192
Name:FRAGOSO-MARTINEZ, DIANA SARAHI (BA PSYCHOLOGY)
Entity Type:Individual
Prefix:MISS
First Name:DIANA
Middle Name:SARAHI
Last Name:FRAGOSO-MARTINEZ
Suffix:
Gender:F
Credentials:BA PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 TURK ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-3329
Mailing Address - Country:US
Mailing Address - Phone:415-928-7800
Mailing Address - Fax:
Practice Address - Street 1:226 MIRIAM ST
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-1947
Practice Address - Country:US
Practice Address - Phone:408-896-7759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-21
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)