Provider Demographics
NPI:1235700576
Name:MARTINEZ, CARLA (RDN, CNSC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RDN, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5860 BENNER ST APT 203
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-4735
Mailing Address - Country:US
Mailing Address - Phone:917-873-1636
Mailing Address - Fax:
Practice Address - Street 1:701 W CESAR E CHAVEZ AVE STE 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2185
Practice Address - Country:US
Practice Address - Phone:213-217-5387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86167894133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered