Provider Demographics
NPI:1356945505
Name:MARTINEZ, THERESE (RD)
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:
Last Name: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 1:141 S POPLAR ST APT D
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-5850
Mailing Address - Country:US
Mailing Address - Phone:360-790-9976
Mailing Address - Fax:
Practice Address - Street 1:141 S POPLAR ST APT D
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-5850
Practice Address - Country:US
Practice Address - Phone:360-790-9976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA86057783133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered