Healthcare Provider Details

I. General information

NPI: 1174920250
Provider Name (Legal Business Name): JANET DIAZ MARTINEZ RD, LD/N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6905 W CAMINO REAL APT 104
BOCA RATON FL
33433-5080
US

IV. Provider business mailing address

6905 W CAMINO REAL APT 104
BOCA RATON FL
33433-5080
US

V. Phone/Fax

Practice location:
  • Phone: 561-409-9369
  • Fax:
Mailing address:
  • Phone: 561-409-9369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND6823
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: