MEDICARE: DAISHA MARTINEZ BSN, RN

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	163WC0400X	Case Management Registered Nurse	852570	NY
2	163WD0400X	Diabetes Educator Registered Nurse	852570	NY
3	163WG0000X	General Practice Registered Nurse	852570	NY
4	163WG0600X	Gerontology Registered Nurse	852570	NY
5	163WH0200X	Home Health Registered Nurse	852570	NY
6	163WS0200X	School Registered Nurse	852570	NY
7	163W00000X	Registered Nurse	852570	NY
8	163WP2201X	Ambulatory Care Registered Nurse	852570	NY

General Provider Information

NPI Number	:	1740064633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAISHA MARTINEZ BSN, RN

Provider Business Mailing Address
First Line	:	452 E 138TH ST # 1002
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10454-3002
Country	:	US
Telephone Number	:	518-660-8979
Fax Number	:

Provider Business Practice Location Address
First Line	:	452 E 138TH ST # 1002
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10454-3002
Country	:	US
Telephone Number	:	518-660-8979
Fax Number	:

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

Provider Enumeration Date	:	08/22/2023
Last Update Date	:	08/23/2023

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