Provider Demographics
NPI:1104534304
Name:MOYEDA CARABAZA, ANA FLORENCIA (PHD, MS, RDN, LMNT)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:FLORENCIA
Last Name:MOYEDA CARABAZA
Suffix:
Gender:F
Credentials:PHD, MS, RDN, LMNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 DINEEN AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4438
Mailing Address - Country:US
Mailing Address - Phone:806-548-7994
Mailing Address - Fax:
Practice Address - Street 1:900 CEDAR ST
Practice Address - Street 2:
Practice Address - City:JULESBURG
Practice Address - State:CO
Practice Address - Zip Code:80737-1121
Practice Address - Country:US
Practice Address - Phone:970-474-3323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1640133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered