Provider Demographics
NPI:1982937355
Name:MARTINEZ, DIANA BEATRICE (RRW)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:BEATRICE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RRW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7525 ELWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1985
Mailing Address - Country:US
Mailing Address - Phone:909-684-6091
Mailing Address - Fax:
Practice Address - Street 1:960 N STATE ST STE B
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-1400
Practice Address - Country:US
Practice Address - Phone:951-652-3560
Practice Address - Fax:951-929-2780
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA333901Medicaid
CA333903Medicaid