Provider Demographics
NPI:1124450531
Name:DFAS-CL/JFLP
Entity type:Organization
Organization Name:DFAS-CL/JFLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPARTMENT HEAD, CLINICAL DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:ELAINA
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:080-416-8704
Mailing Address - Street 1:PSC 475 BOX 1402
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96350-1402
Mailing Address - Country:US
Mailing Address - Phone:0809-174-1584
Mailing Address - Fax:
Practice Address - Street 1:PSC 475 BOX 1402
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96350-1402
Practice Address - Country:US
Practice Address - Phone:0809-174-1584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA964559133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty