Provider Demographics
NPI:1497461701
Name:MARTINEZ, MERISA (MS, RDN)
Entity Type:Individual
Prefix:
First Name:MERISA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 RAINBOW PARKE DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-8021
Mailing Address - Country:US
Mailing Address - Phone:512-785-2264
Mailing Address - Fax:
Practice Address - Street 1:1213 RAINBOW PARKE DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-8021
Practice Address - Country:US
Practice Address - Phone:512-785-2264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X
TX133V00000X
TX86330779133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education