Provider Demographics
NPI:1851122410
Name:HERRERA NARANJO, MARIA MANUELA (RDN)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:MANUELA
Last Name:HERRERA NARANJO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3283 W JORDAN LINE PKWY APT 154
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-7962
Mailing Address - Country:US
Mailing Address - Phone:385-335-3211
Mailing Address - Fax:
Practice Address - Street 1:3283 W JORDAN LINE PKWY APT 154
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-7962
Practice Address - Country:US
Practice Address - Phone:385-335-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT86434543133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered