Provider Demographics
NPI:1376399733
Name:MARTELL, CANDACE (MS, RDN, LDN)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:MARTELL
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-4681
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:620 WOODLAND KNOLLS RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN HILLS
Practice Address - State:IL
Practice Address - Zip Code:61548-9429
Practice Address - Country:US
Practice Address - Phone:815-954-8742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164009704133VN1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics