Provider Demographics
NPI:1790289932
Name:MARTINEZ, LIZETTE (MS, RDN, CDN)
Entity Type:Individual
Prefix:MS
First Name:LIZETTE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MS, RDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 OLD MAMARONECK RD APT 6B
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1911
Mailing Address - Country:US
Mailing Address - Phone:914-255-0167
Mailing Address - Fax:
Practice Address - Street 1:59 OLD MAMARONECK RD APT 6B
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1911
Practice Address - Country:US
Practice Address - Phone:914-255-0167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009335133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered