Provider Demographics
NPI:1558989335
Name:MARTINEZ DE LOERA, ANGELICA (MS, RDN, LD)
Entity Type:Individual
Prefix:MISS
First Name:ANGELICA
Middle Name:
Last Name:MARTINEZ DE LOERA
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7761 ALAMEDA ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73026-3738
Mailing Address - Country:US
Mailing Address - Phone:405-471-4704
Mailing Address - Fax:
Practice Address - Street 1:7761 ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73026-3738
Practice Address - Country:US
Practice Address - Phone:405-471-4704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLD2381133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty