Provider Demographics
NPI:1548518749
Name:MARTORANA, MARISSA (RD)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:MARTORANA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 S MALGREN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3726
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:827 DEEP VALLEY DR
Practice Address - Street 2:STE 309
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3655
Practice Address - Country:US
Practice Address - Phone:310-707-7230
Practice Address - Fax:310-833-6569
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-17
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA961227133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered