Provider Demographics
NPI:1265688923
Name:KANNIKE-MARTINS, JOSEPHINE CHI (DPA, RD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:CHI
Last Name:KANNIKE-MARTINS
Suffix:
Gender:F
Credentials:DPA, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3756 SANTA ROSALIA DR STE 417
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3614
Mailing Address - Country:US
Mailing Address - Phone:323-295-1136
Mailing Address - Fax:323-295-1071
Practice Address - Street 1:3756 SANTA ROSALIA DR STE 417
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-3614
Practice Address - Country:US
Practice Address - Phone:323-295-1136
Practice Address - Fax:323-295-1071
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X133NN1002X
133V00000X133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education