Healthcare Provider Details

I. General information

NPI: 1326873589
Provider Name (Legal Business Name): ANALI MARTINEZ RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 W ANKLAM RD STE 101
TUCSON AZ
85745-2660
US

IV. Provider business mailing address

1712 W ANKLAM RD STE 101
TUCSON AZ
85745-2660
US

V. Phone/Fax

Practice location:
  • Phone: 520-207-2384
  • Fax: 520-367-4297
Mailing address:
  • Phone: 520-207-2384
  • Fax: 520-367-4297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: