Provider Demographics
NPI:1881108017
Name:MARTINEZ, CELINES (RDN)
Entity type:Individual
Prefix:
First Name:CELINES
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:CELINES
Other - Middle Name:
Other - Last Name:RIVERA-SALDANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1313 RED PONY RANCH RD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-7987
Mailing Address - Country:US
Mailing Address - Phone:321-696-5330
Mailing Address - Fax:
Practice Address - Street 1:1313 RED PONY RANCH RD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-7987
Practice Address - Country:US
Practice Address - Phone:321-696-5330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8437133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
1103058OtherACADEMY OF NUTRITION AND DIETETICS
FL8437OtherFLORIDA DEPARTMENT OF HEALTH