Provider Demographics
NPI:1336956465
Name:QUIASUA MEJIA, BIBIANA (RD)
Entity type:Individual
Prefix:
First Name:BIBIANA
Middle Name:
Last Name:QUIASUA MEJIA
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 1:4307 GUMBO LIMBO DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-3170
Mailing Address - Country:US
Mailing Address - Phone:978-398-2597
Mailing Address - Fax:
Practice Address - Street 1:4307 GUMBO LIMBO DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-3170
Practice Address - Country:US
Practice Address - Phone:978-398-2597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND10657133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered