Provider Demographics
NPI:1508107210
Name:VEGA-MARTINEZ, MARIA CRISTINA (RD, CDE)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CRISTINA
Last Name:VEGA-MARTINEZ
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:
Other - Last Name:VEGA-MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:85 NEILSON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2485
Mailing Address - Country:US
Mailing Address - Phone:831-763-6445
Mailing Address - Fax:
Practice Address - Street 1:85 NEILSON ST STE 201
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2485
Practice Address - Country:US
Practice Address - Phone:831-763-6445
Practice Address - Fax:831-724-0877
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA804752133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered