MEDICARE: DIANA MARTINEZ MBA

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
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1295154268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA MARTINEZ MBA

Provider Business Mailing Address
First Line	:	PO BOX 721082
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75372-1082
Country	:	US
Telephone Number	:	214-620-8253
Fax Number	:

Provider Business Practice Location Address
First Line	:	2528 SAN MEDINA AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-3114
Country	:	US
Telephone Number	:	214-620-8253
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2014
Last Update Date	:	04/07/2014

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