Provider Demographics
NPI:1457112112
Name:RUSINARU, CARMEN AURORA (PHD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:AURORA
Last Name:RUSINARU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:AURORA
Other - Last Name:TEODORESCU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 11223
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98909-2223
Mailing Address - Country:US
Mailing Address - Phone:503-432-5384
Mailing Address - Fax:
Practice Address - Street 1:1216 S 40TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-6023
Practice Address - Country:US
Practice Address - Phone:503-432-5384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist