Provider Demographics
NPI:1316391709
Name:MARTINEZ, DAYANA R
Entity Type:Individual
Prefix:
First Name:DAYANA
Middle Name:R
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 SW 164TH TER
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST RANCHES
Mailing Address - State:FL
Mailing Address - Zip Code:33331-1377
Mailing Address - Country:US
Mailing Address - Phone:305-456-3577
Mailing Address - Fax:305-456-3574
Practice Address - Street 1:4920 SW 164TH TER
Practice Address - Street 2:
Practice Address - City:SOUTHWEST RANCHES
Practice Address - State:FL
Practice Address - Zip Code:33331-1377
Practice Address - Country:US
Practice Address - Phone:305-456-3577
Practice Address - Fax:305-456-3574
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty