Healthcare Provider Details

I. General information

NPI: 1528073277
Provider Name (Legal Business Name): KATTIA M CORRALES-YAUCKOES MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JOSLIN PL JOSLIN CLINIC, PEDIATRIC, ADOLESCENT AND YOUNG ADULT
BOSTON MA
02215-5306
US

IV. Provider business mailing address

495 ARBORWAY APT 32
JAMAICA PLAIN MA
02130-3660
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-2603
  • Fax:
Mailing address:
  • Phone: 617-983-3248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number27
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number27
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: