Provider Demographics
NPI:1497021596
Name:AMOR-MARTINEZ, VIVIAN ELENA (RD,LD)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:ELENA
Last Name:AMOR-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 1:7574 W 5TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4921
Mailing Address - Country:US
Mailing Address - Phone:305-231-1168
Mailing Address - Fax:
Practice Address - Street 1:551 W 51ST PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3601
Practice Address - Country:US
Practice Address - Phone:305-364-3119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND26000133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered