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NPI Code Detail

MEDICARE: MARIA FERNANDA MARTINEZ DIAZ DE LEON

MEDICARE: MARIA FERNANDA MARTINEZ DIAZ DE LEON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1205667532
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA FERNANDA MARTINEZ DIAZ DE LEON
Provider Business Mailing Address
First Line : 5840 CAMERON RUN TER APT 728
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22303-1892
Country : US
Telephone Number : 832-541-4823
Fax Number :
Provider Business Practice Location Address
First Line : 4342 4TH ST N
Second Line :
City : ARLINGTON
State : VA
Zip : 22203-3068
Country : US
Telephone Number : 571-317-1446
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2024
Last Update Date : 08/08/2024

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Directions to “ MARIA FERNANDA MARTINEZ DIAZ DE LEON ” Practice Location

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