Individual
TERESA MARIE MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, CD
Contact information
Practice address
28 S 100 E, PRICE, UT 84501-3002
(435) 637-3671
Mailing address
625 W 200 S, PRICE, UT 84501-3205
(435) 650-9455
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
5748433-4901
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D6545 999000021033
—
UT
Enumeration date
10/04/2007
Last updated
10/04/2007
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