Provider Demographics
NPI:1972708741
Name:MORALES, MARIEL (RDN LDN)
Entity type:Individual
Prefix:MRS
First Name:MARIEL
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:RDN LDN
Other - Prefix:MRS
Other - First Name:MARIEL
Other - Middle Name:
Other - Last Name:MORALES-ROSARIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, CDE
Mailing Address - Street 1:3440 N GOLDENROD RD APT 517
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-8768
Mailing Address - Country:US
Mailing Address - Phone:407-558-2962
Mailing Address - Fax:321-404-1019
Practice Address - Street 1:3440 N GOLDENROD RD APT 517
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-8768
Practice Address - Country:US
Practice Address - Phone:407-558-2962
Practice Address - Fax:321-404-1019
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
914955133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered