Provider Demographics
NPI:1902491996
Name:MORALES-MARTINEZ, MIA MICHELLE (RDN)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:MICHELLE
Last Name:MORALES-MARTINEZ
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 COUNTY ROAD 7630
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-4633
Mailing Address - Country:US
Mailing Address - Phone:806-445-9135
Mailing Address - Fax:
Practice Address - Street 1:2314 COUNTY ROAD 7630
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-4633
Practice Address - Country:US
Practice Address - Phone:806-445-9135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered