Healthcare Provider Details

I. General information

NPI: 1720991367
Provider Name (Legal Business Name): CASSIDY DIANNA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4516 VALLEY DR
N LAS VEGAS NV
89031-0127
US

IV. Provider business mailing address

4516 VALLEY DR
N LAS VEGAS NV
89031-0127
US

V. Phone/Fax

Practice location:
  • Phone: 702-506-1434
  • Fax:
Mailing address:
  • Phone: 702-506-1434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: