Provider Demographics
NPI:1467095513
Name:MARTINEZ, SOPHIA MARIA (MS, RDN, LD)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:MARIA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:MARIA
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RDN, LD
Mailing Address - Street 1:2829 23RD ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1627
Mailing Address - Country:US
Mailing Address - Phone:575-499-8460
Mailing Address - Fax:
Practice Address - Street 1:6104 AVENUE Q
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79412-3506
Practice Address - Country:US
Practice Address - Phone:806-472-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD-1205133V00000X
TXDT85223133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered