Provider Demographics
NPI:1447738794
Name:MARTINEZ, GUADALUPE DIANA
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:DIANA
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 1:20001 PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-6508
Mailing Address - Country:US
Mailing Address - Phone:818-717-1000
Mailing Address - Fax:818-717-8799
Practice Address - Street 1:20001 PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-6508
Practice Address - Country:US
Practice Address - Phone:818-717-1000
Practice Address - Fax:818-717-8799
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator