Provider Demographics
NPI:1447607353
Name:FERRAZ VALLES, MARTA (MA, RDN, LD)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:FERRAZ VALLES
Suffix:
Gender:F
Credentials:MA, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 CORRY VLG APT 1
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32603-2134
Mailing Address - Country:US
Mailing Address - Phone:580-279-8602
Mailing Address - Fax:
Practice Address - Street 1:279 CORRY VLG APT 1
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32603-2134
Practice Address - Country:US
Practice Address - Phone:580-279-8602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 7726133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered