Provider Demographics
NPI:1568226777
Name:ORTIZ-KENNEDY, DIANA LAURA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LAURA
Last Name:ORTIZ-KENNEDY
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 1:1060 MAYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4167
Mailing Address - Country:US
Mailing Address - Phone:909-441-1189
Mailing Address - Fax:
Practice Address - Street 1:25 ALLEN STREET
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553
Practice Address - Country:US
Practice Address - Phone:925-515-9296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker