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NPI Code Detail

MEDICARE: CHARISSE MARTIN RD, LD

MEDICARE: CHARISSE MARTIN 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 DietitianDT85078TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1H08QM04501OTHERTXBCBS

General Provider Information

NPI Number : 1760984603
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARISSE MARTIN RD, LD
Provider Business Mailing Address
First Line : 215 E MONTE CRISTO RD
Second Line :
City : EDINBURG
State : TX
Zip : 78541-8630
Country : US
Telephone Number : 956-802-7476
Fax Number :
Provider Business Practice Location Address
First Line : 1001 RONE DR STE 2
Second Line :
City : WESLACO
State : TX
Zip : 78596-5043
Country : US
Telephone Number : 956-802-7476
Fax Number : 956-447-1035
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2018
Last Update Date : 11/04/2021

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Directions to “ CHARISSE MARTIN RD, LD” Practice Location

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