Provider Demographics
NPI:1376080085
Name:MARTINEZ, DIANA CAROLINA (BS)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:CAROLINA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:CAROLINA
Other - Last Name:BUITRAGO-MONTOYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:645 18TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962
Mailing Address - Country:US
Mailing Address - Phone:772-834-1608
Mailing Address - Fax:
Practice Address - Street 1:645 18TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32962-1424
Practice Address - Country:US
Practice Address - Phone:772-834-1608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator