Provider Demographics
NPI:1235731837
Name:MARTINEZ SOBERAL, EDITZEL MARIE (RDN, LND)
Entity Type:Individual
Prefix:
First Name:EDITZEL
Middle Name:MARIE
Last Name:MARTINEZ SOBERAL
Suffix:
Gender:F
Credentials:RDN, LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 25895
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-9484
Mailing Address - Country:US
Mailing Address - Phone:787-560-4592
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 KM 93.1
Practice Address - Street 2:BO MEMBRILLO
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627
Practice Address - Country:US
Practice Address - Phone:787-560-4592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered