Provider Demographics
NPI:1619633195
Name:BANUELOS, MARTA E (NUTRITIONIST, MS)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:E
Last Name:BANUELOS
Suffix:
Gender:F
Credentials:NUTRITIONIST, MS
Other - Prefix:
Other - First Name:MARTA
Other - Middle Name:E
Other - Last Name:OLTARZEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NUTRITIONIST, MS
Mailing Address - Street 1:504 BEACON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-1042
Mailing Address - Country:US
Mailing Address - Phone:617-615-9198
Mailing Address - Fax:
Practice Address - Street 1:504 BEACON ST STE 1
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-1042
Practice Address - Country:US
Practice Address - Phone:415-999-8393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education