Provider Demographics
NPI:1548021124
Name:ROSS, CECILIA ILEANA (CDCES, RD)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:ILEANA
Last Name:ROSS
Suffix:
Gender:F
Credentials:CDCES, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3071 S JOPLIN CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-1640
Mailing Address - Country:US
Mailing Address - Phone:719-510-1977
Mailing Address - Fax:
Practice Address - Street 1:14300 ORCHARD PKWY
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80023-9206
Practice Address - Country:US
Practice Address - Phone:719-510-1977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO133V00000X
86117406133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered