| NPI | 1679131361 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARILYN AMAYA Provider Enrollment Specialist 508-334-6503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered |
| Additional Taxonomies | 133VN1004X Dietitian, Registered, Nutrition, Pediatric |
| 133VN1005X Dietitian, Registered, Nutrition, Renal | |
| 133VN1006X Dietitian, Registered, Nutrition, Metabolic | |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2019-05-29 |