Provider Demographics
NPI:1245996842
Name:MARTINEZ CHALUISANT, JACQUELINE (RDN)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:MARTINEZ CHALUISANT
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CALLE 1 APT I318
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-2469
Mailing Address - Country:US
Mailing Address - Phone:787-484-0384
Mailing Address - Fax:
Practice Address - Street 1:CALLE 266 AVE. EL COMANDANTE
Practice Address - Street 2:3RD EXT. COUNTRY CLUB
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982-2767
Practice Address - Country:US
Practice Address - Phone:787-484-0384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR982631133V00000X
PR1557133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education