Healthcare Provider Details

I. General information

NPI: 1700121969
Provider Name (Legal Business Name): CRISTINE SEITZ MS RD LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2012
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 STATION ST STE 100
BROOKLINE MA
02445-7995
US

IV. Provider business mailing address

17 STATION ST STE 100
BROOKLINE MA
02445-7995
US

V. Phone/Fax

Practice location:
  • Phone: 774-315-3056
  • Fax: 857-216-8558
Mailing address:
  • Phone: 774-315-3056
  • Fax: 857-216-8558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3399
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: