Provider Demographics
NPI:1811266216
Name:MARTINEZ, DIANA PAOLA (PA-C)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:PAOLA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4308 ALTON RD
Mailing Address - Street 2:SUITE 830
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-4556
Mailing Address - Country:US
Mailing Address - Phone:305-532-7494
Mailing Address - Fax:305-532-9793
Practice Address - Street 1:4308 ALTON RD
Practice Address - Street 2:SUITE 830
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-4556
Practice Address - Country:US
Practice Address - Phone:305-532-7494
Practice Address - Fax:305-532-9793
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105777363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9105777OtherPA LICENSE