Provider Demographics
NPI:1497332365
Name:DIAZ MARTINEZ, IVONNE (BA)
Entity Type:Individual
Prefix:
First Name:IVONNE
Middle Name:
Last Name:DIAZ MARTINEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 CHANSLOR AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-3646
Mailing Address - Country:US
Mailing Address - Phone:415-573-5908
Mailing Address - Fax:
Practice Address - Street 1:205 39TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-2212
Practice Address - Country:US
Practice Address - Phone:510-412-5930
Practice Address - Fax:510-412-0567
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health