Provider Demographics
NPI:1427593391
Name:HUIZAR, MARTHA IMELDA (MS, RD, CLC)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:IMELDA
Last Name:HUIZAR
Suffix:
Gender:F
Credentials:MS, RD, CLC
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:IMELDA
Other - Last Name:MOSQUEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1479 N ARDEN AVE # 3471
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS
Mailing Address - State:AZ
Mailing Address - Zip Code:85336-0768
Mailing Address - Country:US
Mailing Address - Phone:928-920-4584
Mailing Address - Fax:
Practice Address - Street 1:851 N MAIN ST STE 1&3
Practice Address - Street 2:
Practice Address - City:SAN LUIS
Practice Address - State:AZ
Practice Address - Zip Code:85336-0685
Practice Address - Country:US
Practice Address - Phone:928-920-4584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-30
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133VN1101XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Gerontological
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Oncology
No133VN1401XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric Critical Care
No133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1105437OtherCOMMISSION ON DIETETIC REGISTRATION - REGISTERED DIETITIAN