Healthcare Provider Details

I. General information

NPI: 1720258320
Provider Name (Legal Business Name): MS. A. DIANE MARTELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 SAVIERS RD
OXNARD CA
93033-3608
US

IV. Provider business mailing address

7246 REMMET AVE
CANOGA PARK CA
91303-1531
US

V. Phone/Fax

Practice location:
  • Phone: 805-483-2253
  • Fax:
Mailing address:
  • Phone: 818-206-0360
  • Fax: 818-206-0382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMP1906
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: