Provider Demographics
NPI:1083815310
Name:MARTINEZ, KATHRYN FINK (MS, RD, LD, CEDRD-S)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:FINK
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MS, RD, LD, CEDRD-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 WALLIN DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-5716
Mailing Address - Country:US
Mailing Address - Phone:214-449-0564
Mailing Address - Fax:
Practice Address - Street 1:2701 WALLIN DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-5716
Practice Address - Country:US
Practice Address - Phone:214-449-0564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT05924133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered