Individual
CHARISSE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
1001 RONE DR STE 2, WESLACO, TX 78596-5043
(956) 802-7476
(956) 447-1035
Mailing address
215 E MONTE CRISTO RD, EDINBURG, TX 78541-8630
(956) 802-7476
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT85078
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H08QM04501
BCBS
TX
Enumeration date
03/07/2018
Last updated
11/04/2021
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