Healthcare Provider Details

I. General information

NPI: 1982937355
Provider Name (Legal Business Name): DIANA BEATRICE MARTINEZ RRW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 N STATE ST STE B
HEMET CA
92543-1400
US

IV. Provider business mailing address

7525 ELWOOD AVE
FONTANA CA
92336-1985
US

V. Phone/Fax

Practice location:
  • Phone: 951-652-3560
  • Fax: 951-929-2780
Mailing address:
  • Phone: 909-684-6091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: