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NPI Code Detail

MEDICARE: MARTHA HERNANDEZ RD, LD

MEDICARE:   MARTHA  HERNANDEZ  RD, LD
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
1133V00000XRegistered DietitianNV

General Provider Information

NPI Number : 1487054276
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTHA HERNANDEZ RD, LD
Provider Business Mailing Address
First Line : 3006 S MARYLAND PKWY STE 515
Second Line :
City : LAS VEGAS
State : NV
Zip : 89109-2244
Country : US
Telephone Number : 702-732-1290
Fax Number : 702-733-4961
Provider Business Practice Location Address
First Line : 3006 S MARYLAND PKWY STE 515
Second Line :
City : LAS VEGAS
State : NV
Zip : 89109-2244
Country : US
Telephone Number : 702-732-1290
Fax Number : 702-733-4961
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2014
Last Update Date : 08/28/2014

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Directions to “ MARTHA HERNANDEZ RD, LD” Practice Location

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