Individual
ANGELIQUE M MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.D.
Contact information
Practice address
4140 W MEMORIAL RD STE 321, OKLAHOMA CITY, OK 73120
(405) 748-4726
(405) 607-8497
Mailing address
4140 W MEMORIAL RD STE 321, OKLAHOMA CITY, OK 73120-8300
(405) 748-4726
(405) 607-8497
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
1796
AR
133V00000X
Registered Dietitian
Primary
970
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100166870A
—
OK
01
—
970
LD LICENSE
OK
Enumeration date
09/21/2006
Last updated
01/10/2020
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