Provider Demographics
NPI:1417143876
Name:MARTINEZ, MELISSA K (MS, RD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:K
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MS, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9505 N SOMMERVILLE DR
Mailing Address - Street 2:SUITE 102, BOX 7
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-5477
Mailing Address - Country:US
Mailing Address - Phone:559-435-1595
Mailing Address - Fax:559-435-5420
Practice Address - Street 1:7055 N CHESTNUT AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0350
Practice Address - Country:US
Practice Address - Phone:559-840-2170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA833408133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered