Healthcare Provider Details

I. General information

NPI: 1801157920
Provider Name (Legal Business Name): TONI DIANA MARTELLO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 1ST ST TRADITIONS BEHAVIORAL HEALTH
NAPA CA
94559-2841
US

IV. Provider business mailing address

1580 1ST ST TRADITIONS BEHAVIORAL HEALTH
NAPA CA
94559-2841
US

V. Phone/Fax

Practice location:
  • Phone: 707-258-8757
  • Fax:
Mailing address:
  • Phone: 707-258-8757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number143375
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number275427
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: