Provider Demographics
NPI:1851930580
Name:MARTINEZ, MARIELENA RENAEE (BSHN)
Entity Type:Individual
Prefix:MS
First Name:MARIELENA
Middle Name:RENAEE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:BSHN
Other - Prefix:
Other - First Name:MARIELENA
Other - Middle Name:RENAEE
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3310 RODD FIELD RD APT 10106
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-2143
Mailing Address - Country:US
Mailing Address - Phone:361-474-0918
Mailing Address - Fax:
Practice Address - Street 1:3310 RODD FIELD RD APT 10106
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2143
Practice Address - Country:US
Practice Address - Phone:361-474-0918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-28
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist