Provider Demographics
NPI: | 1003944901 |
---|---|
Name: | PALOTTA, MARTHA LEE (RD REGISTERED DIETIT) |
Entity Type: | Individual |
Prefix: | MRS |
First Name: | MARTHA |
Middle Name: | LEE |
Last Name: | PALOTTA |
Suffix: | |
Gender: | F |
Credentials: | RD REGISTERED DIETIT |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 5211 ESSEN LANE |
Mailing Address - Street 2: | SUITE 8A |
Mailing Address - City: | BATON ROUGE |
Mailing Address - State: | LA |
Mailing Address - Zip Code: | 70809 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 225-767-9009 |
Mailing Address - Fax: | 225-767-5100 |
Practice Address - Street 1: | 5211 ESSEN LANE |
Practice Address - Street 2: | SUITE 8A |
Practice Address - City: | BATON ROUGE |
Practice Address - State: | LA |
Practice Address - Zip Code: | 70809 |
Practice Address - Country: | US |
Practice Address - Phone: | 225-767-9009 |
Practice Address - Fax: | 225-767-5100 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-03-01 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
LA | 634 | 133N00000X, 133V00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Not Answered | 133N00000X | Dietary & Nutritional Service Providers | Nutritionist | |
Not Answered | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
4C027 | Medicare ID - Type Unspecified |