Provider Demographics
NPI:1366717365
Name:MARTINEZ, LOURDES INES (MS, RD/LD)
Entity type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:INES
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:MS, RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 SW 21ST TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2616
Mailing Address - Country:US
Mailing Address - Phone:786-417-4099
Mailing Address - Fax:
Practice Address - Street 1:2140 SW 21ST TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2616
Practice Address - Country:US
Practice Address - Phone:786-417-4099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND1885133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered