Healthcare Provider Details

I. General information

NPI: 1952945917
Provider Name (Legal Business Name): VIOLETA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2019
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 W MAIN ST STE 130
WEIMAR TX
78962-1913
US

IV. Provider business mailing address

406 W MAIN ST STE 130
WEIMAR TX
78962-1913
US

V. Phone/Fax

Practice location:
  • Phone: 979-505-1599
  • Fax:
Mailing address:
  • Phone: 979-505-1599
  • Fax: 979-289-7449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberDT86092
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT86092
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License NumberDT86092
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberDT86092
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: