Provider Demographics
NPI:1598994519
Name:MARTIN, CARMEN M (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8065 STIRRUP CAY CT
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-1735
Mailing Address - Country:US
Mailing Address - Phone:561-214-3788
Mailing Address - Fax:561-214-3788
Practice Address - Street 1:8065 STIRRUP CAY CT
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-1735
Practice Address - Country:US
Practice Address - Phone:561-214-3788
Practice Address - Fax:561-214-3788
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-12
Last Update Date:2009-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4233133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered