Basic Information
Provider Information | |||||||||
NPI: | 1124283759 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CRESCIONI | ||||||||
FirstName: | MARIA | ||||||||
MiddleName: | BELINDA | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | R.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 70344 | ||||||||
Address2: | PMB 438 | ||||||||
City: | SAN JUAN | ||||||||
State: | PR | ||||||||
PostalCode: | 009368344 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7877773535 | ||||||||
FaxNumber: | 7877568907 | ||||||||
Practice Location | |||||||||
Address1: | CARRETERA 22 BARRIO MONACILLOS | ||||||||
Address2: | TERRENOS CENTRO MEDICO | ||||||||
City: | RIO PIEDRAS | ||||||||
State: | PR | ||||||||
PostalCode: | 00935 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7877773535 | ||||||||
FaxNumber: | 7877568907 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/23/2008 | ||||||||
LastUpdateDate: | 07/23/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133VN1004X | 668753 | PR | Y |   | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Pediatric |
No ID Information.