Basic Information
| Provider Information | |||||||||
| NPI: | 1811266216 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | PAOLA | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4308 ALTON RD | ||||||||
| Address2: | SUITE 830 | ||||||||
| City: | MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331404556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055327494 | ||||||||
| FaxNumber: | 3055329793 | ||||||||
| Practice Location | |||||||||
| Address1: | 4308 ALTON RD | ||||||||
| Address2: | SUITE 830 | ||||||||
| City: | MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331404556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055327494 | ||||||||
| FaxNumber: | 3055329793 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2011 | ||||||||
| LastUpdateDate: | 03/13/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA9105777 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | PA9105777 | 01 | FL | PA LICENSE | OTHER |