Provider Demographics
NPI:1215710801
Name:DE MAA PARRA, MITZI ESTEFANIA (RD)
Entity type:Individual
Prefix:
First Name:MITZI
Middle Name:ESTEFANIA
Last Name:DE MAA PARRA
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 1:5338 NORTHDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-6731
Mailing Address - Country:US
Mailing Address - Phone:954-492-7187
Mailing Address - Fax:
Practice Address - Street 1:5338 NORTHDALE BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-6731
Practice Address - Country:US
Practice Address - Phone:954-492-7187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND11996133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered