Provider Demographics
NPI:1336146331
Name:WILKINS, MARTHA (RD)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:
Last Name:WILKINS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 W LOS OLIVOS ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4214
Mailing Address - Country:US
Mailing Address - Phone:805-569-2652
Mailing Address - Fax:805-563-9493
Practice Address - Street 1:1704 STATE ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2522
Practice Address - Country:US
Practice Address - Phone:805-569-2652
Practice Address - Fax:805-563-9493
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435274133V00000X, 133VN1005X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMNT435274Medicare ID - Type UnspecifiedDIETITIAN