Provider Demographics
NPI:1376090043
Name:JANET DIAZ MARTINEZ
Entity type:Organization
Organization Name:JANET DIAZ MARTINEZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:561-409-9369
Mailing Address - Street 1:5353 W ATLANTIC AVE
Mailing Address - Street 2:SUITE 400-A
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8174
Mailing Address - Country:US
Mailing Address - Phone:561-495-1515
Mailing Address - Fax:866-214-6612
Practice Address - Street 1:5353 W ATLANTIC AVE
Practice Address - Street 2:SUITE 400-A
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8174
Practice Address - Country:US
Practice Address - Phone:561-495-1515
Practice Address - Fax:866-214-6612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6823261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIC987AMedicare PIN