Provider Demographics
NPI:1366319832
Name:MIRALLES, TATIANA (RD)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:MIRALLES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:TATIANA
Other - Middle Name:
Other - Last Name:LARIONOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:5005 NAHANT ST
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-2462
Mailing Address - Country:US
Mailing Address - Phone:305-469-2933
Mailing Address - Fax:
Practice Address - Street 1:5005 NAHANT ST
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20816-2462
Practice Address - Country:US
Practice Address - Phone:305-469-2933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-20
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX6793133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty