Provider Demographics
NPI:1942697925
Name:MARTIN, LANI (RD)
Entity Type:Individual
Prefix:
First Name:LANI
Middle Name:
Last Name:MARTIN
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 1:42750 OLD BICKEL PL
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER MILLS
Mailing Address - State:CA
Mailing Address - Zip Code:96028-9782
Mailing Address - Country:US
Mailing Address - Phone:530-336-5245
Mailing Address - Fax:
Practice Address - Street 1:42750 OLD BICKEL PL
Practice Address - Street 2:
Practice Address - City:FALL RIVER MILLS
Practice Address - State:CA
Practice Address - Zip Code:96028-9782
Practice Address - Country:US
Practice Address - Phone:530-336-5245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA561742133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered