MEDICARE: MARTHA IMELDA HUIZAR MS, RD, CLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	133N00000X	Nutritionist
2	133NN1002X	Nutrition Education Nutritionist
3	133VN1004X	Pediatric Nutrition Registered Dietitian
4	133VN1005X	Renal Nutrition Registered Dietitian
5	133VN1006X	Metabolic Nutrition Registered Dietitian
6	133VN1101X	Gerontological Nutrition Registered Dietitian
7	133VN1201X	Obesity and Weight Management Nutrition Registered Dietitian
8	133VN1301X	Oncology Nutrition Registered Dietitian
9	133VN1401X	Pediatric Critical Care Nutrition Registered Dietitian
10	133VN1501X	Sports Dietetics Nutrition Registered Dietitian
11	133V00000X	Registered Dietitian

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1105437	OTHER	AZ	COMMISSION ON DIETETIC REGISTRATION - REGISTERED DIETITIAN

General Provider Information

NPI Number	:	1427593391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA IMELDA HUIZAR MS, RD, CLC

Provider Business Mailing Address
First Line	:	1479 N ARDEN AVE # 3471
Second Line	:
City	:	SAN LUIS
State	:	AZ
Zip	:	85336-0768
Country	:	US
Telephone Number	:	928-920-4584
Fax Number	:

Provider Business Practice Location Address
First Line	:	851 N MAIN ST STE 1&3
Second Line	:
City	:	SAN LUIS
State	:	AZ
Zip	:	85336-0685
Country	:	US
Telephone Number	:	928-920-4584
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2016
Last Update Date	:	03/20/2022

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