Healthcare Provider Details

I. General information

NPI: 1407301831
Provider Name (Legal Business Name): DIANA BERENICE MARTINEZ DE LA CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9343 TECH CENTER DR STE 200
SACRAMENTO CA
95826-2592
US

IV. Provider business mailing address

2811 EDISON AVE
SACRAMENTO CA
95821-2463
US

V. Phone/Fax

Practice location:
  • Phone: 916-388-6400
  • Fax:
Mailing address:
  • Phone: 916-388-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW136268
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: