Provider Demographics
NPI:1740064633
Name:MARTINEZ, DAISHA (BSN, RN)
Entity type:Individual
Prefix:
First Name:DAISHA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 E 138TH ST # 1002
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-3002
Mailing Address - Country:US
Mailing Address - Phone:518-660-8979
Mailing Address - Fax:
Practice Address - Street 1:452 E 138TH ST # 1002
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-3002
Practice Address - Country:US
Practice Address - Phone:518-660-8979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY852570163WC0400X, 163WD0400X, 163WG0000X, 163WG0600X, 163WH0200X, 163WS0200X, 163W00000X, 163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care