Provider Demographics
NPI:1124735741
Name:MARTIN, JASEL DENEICE (DRPH)
Entity type:Individual
Prefix:DR
First Name:JASEL
Middle Name:DENEICE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DRPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 CLOUDED WREN DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76005-1416
Mailing Address - Country:US
Mailing Address - Phone:678-508-8052
Mailing Address - Fax:
Practice Address - Street 1:1806 CLOUDED WREN DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76005-1416
Practice Address - Country:US
Practice Address - Phone:678-508-8052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No174H00000XOther Service ProvidersHealth Educator