Healthcare Provider Details

I. General information

NPI: 1487377479
Provider Name (Legal Business Name): YANETH MARTINEZ DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RANCHO CORDOVA CHILDREN'S CENTER 9837 FOLSOM BOULEVARD, SUITE F
SACRAMENTO CA
95827
US

IV. Provider business mailing address

RANCHO CORDOVA CHILDREN'S CENTER 9837 FOLSOM BOULEVARD, SUITE F
SACRAMENTO CA
95827
US

V. Phone/Fax

Practice location:
  • Phone: 916-450-2600
  • Fax: 916-856-5708
Mailing address:
  • Phone: 916-450-2600
  • Fax: 916-856-5708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: