Provider Demographics
NPI:1154004323
Name:MARTINEZ, DIAMON DALLAS
Entity type:Individual
Prefix:
First Name:DIAMON
Middle Name:DALLAS
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 S MEADOWS PKWY APT K2075
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-3929
Mailing Address - Country:US
Mailing Address - Phone:702-756-4426
Mailing Address - Fax:
Practice Address - Street 1:1205 S MEADOWS PKWY APT K2075
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-3929
Practice Address - Country:US
Practice Address - Phone:702-756-4426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula