Provider Demographics
NPI:1497338651
Name:MARTIN, DILLON J (RDN)
Entity Type:Individual
Prefix:
First Name:DILLON
Middle Name:J
Last Name:MARTIN
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2183 TORTONA ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-0551
Mailing Address - Country:US
Mailing Address - Phone:702-375-4494
Mailing Address - Fax:
Practice Address - Street 1:2183 TORTONA ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89044-0551
Practice Address - Country:US
Practice Address - Phone:702-375-4494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV39371-DI-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered