Martha Vallejo Diaz, LPT

Primary specialty

Licensed Psychiatric TechnicianTaxonomy code 167G00000X

License

29462 Issued in CA

Practice address

11277 Garden Grove Blvd Ste 100
Garden Grove, CA 92843-1300

Phone

(714) 620-8131

NPI assigned

Jun 3, 2016

Last updated

Feb 2, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• College Community Services

  dba Clarvida

  • Community/Behavioral Health Agency
  • Tehachapi, CA
  • NPI 1831870500
  NPD (past)
• College Community Services

  dba AMHS Clarvida Opportunity Knocks FSP

  • Community/Behavioral Health Agency
  • Anaheim, CA
  • NPI 1841335692
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1464912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612224000000",
    "number": "1275982977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11277 GARDEN GROVE BLVD STE 100",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431300",
            "telephone_number": "714-620-8131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11277 GARDEN GROVE BLVD STE 100",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431300",
            "telephone_number": "714-620-8131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIAZ",
        "first_name": "MARTHA",
        "middle_name": "VALLEJO",
        "credential": "LPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-06-03",
        "last_updated": "2021-02-02",
        "certification_date": "2021-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "167G00000X",
            "taxonomy_group": "",
            "desc": "Licensed Psychiatric Technician",
            "state": "CA",
            "license": "29462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• George Diaz
• Henry Francisco Diaz
• Laura Diaz
• Mariana Diaz
• Marissa M Diaz, LCSW, PPSC
• Mayaning Diaz
• Paulette Diaz
• Raul Diaz, RN
• Sasha Diaz, MA
• Taylor Diaz

• Licensed Psychiatric Technician in Garden Grove, CA
• Providers in Garden Grove, CA by specialty
• Licensed Psychiatric Technician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.