Provider Demographics
NPI:1427753276
Name:BONFIGLIO, CIANA (MS, RDN, LDN, CHES)
Entity type:Individual
Prefix:
First Name:CIANA
Middle Name:
Last Name:BONFIGLIO
Suffix:
Gender:F
Credentials:MS, RDN, LDN, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 SEALOFTS DR APT 401
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-3735
Mailing Address - Country:US
Mailing Address - Phone:574-596-1412
Mailing Address - Fax:
Practice Address - Street 1:607 SEALOFTS DR APT 401
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3735
Practice Address - Country:US
Practice Address - Phone:574-596-1412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11997133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered