Provider Demographics
NPI:1104280130
Name:MOZITIS, JILLIAN (RD)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:MOZITIS
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 1:111 ROBBINS AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:PA
Mailing Address - Zip Code:19046-4252
Mailing Address - Country:US
Mailing Address - Phone:267-526-0020
Mailing Address - Fax:
Practice Address - Street 1:111 ROBBINS AVE
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:PA
Practice Address - Zip Code:19046-4252
Practice Address - Country:US
Practice Address - Phone:267-303-8241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133V00000X
PADN005574133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered