Provider Demographics
NPI:1174016208
Name:GARCIA MARTINEZ, DIANA JUDITH (RBT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:JUDITH
Last Name:GARCIA MARTINEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:JUDITH
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:707 CIVIC CENTER DR STE 202
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-6162
Mailing Address - Country:US
Mailing Address - Phone:760-294-1206
Mailing Address - Fax:949-726-8324
Practice Address - Street 1:707 CIVIC CENTER DR STE 202
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-6162
Practice Address - Country:US
Practice Address - Phone:760-294-1206
Practice Address - Fax:949-474-1493
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1857404106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician