Provider Demographics
NPI:1487054276
Name:HERNANDEZ, MARTHA (RD, LD)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 S MARYLAND PKWY STE 515
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2244
Mailing Address - Country:US
Mailing Address - Phone:702-732-1290
Mailing Address - Fax:702-733-4961
Practice Address - Street 1:3006 S MARYLAND PKWY STE 515
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2244
Practice Address - Country:US
Practice Address - Phone:702-732-1290
Practice Address - Fax:702-733-4961
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered