MEDICARE: JONATHAN THEODORE MARTINEZ MS, RD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86377849	FL

General Provider Information

NPI Number	:	1447032453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN THEODORE MARTINEZ MS, RD

Provider Business Mailing Address
First Line	:	9010 ARABIAN DR APT 311
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-1511
Country	:	US
Telephone Number	:	505-315-1390
Fax Number	:

Provider Business Practice Location Address
First Line	:	9010 ARABIAN DR APT 311
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-1511
Country	:	US
Telephone Number	:	816-861-4700
Fax Number	:

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

Provider Enumeration Date	:	10/16/2023
Last Update Date	:	01/12/2026

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