Provider Demographics
NPI:1912220401
Name:VENA-MARTINEZ, MARCELA MARTA (RD)
Entity Type:Individual
Prefix:MS
First Name:MARCELA
Middle Name:MARTA
Last Name:VENA-MARTINEZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2742 THURMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-2428
Mailing Address - Country:US
Mailing Address - Phone:323-931-0645
Mailing Address - Fax:323-931-0645
Practice Address - Street 1:2742 THURMAN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-2428
Practice Address - Country:US
Practice Address - Phone:323-931-0645
Practice Address - Fax:323-931-0645
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA990850133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered