Provider Demographics
NPI:1992537120
Name:BERTHOUMIEUX, CHRISTINE ASHLEY (RD)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ASHLEY
Last Name:BERTHOUMIEUX
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2093 PHILADELPHIA PIKE # 9455
Mailing Address - Street 2:
Mailing Address - City:CLAYMONT
Mailing Address - State:DE
Mailing Address - Zip Code:19703-2424
Mailing Address - Country:US
Mailing Address - Phone:646-465-0475
Mailing Address - Fax:
Practice Address - Street 1:941 N LEITHGOW ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-1430
Practice Address - Country:US
Practice Address - Phone:646-465-0475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010767133V00000X
PADN008445133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered