Provider Demographics
NPI:1407214331
Name:MARTINEZ, DANIEL (RD, LD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 153118
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78715-3118
Mailing Address - Country:US
Mailing Address - Phone:888-512-1673
Mailing Address - Fax:979-530-9551
Practice Address - Street 1:203 ABSHIRE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78237-2305
Practice Address - Country:US
Practice Address - Phone:210-383-2712
Practice Address - Fax:979-530-9551
Is Sole Proprietor?:No
Enumeration Date:2016-02-06
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
TXDT80737133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered