Healthcare Provider Details

I. General information

NPI: 1932458338
Provider Name (Legal Business Name): KARLA PATRIZIA MERCED RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MAPLE ST
HOLYOKE MA
01040-5144
US

IV. Provider business mailing address

230 MAPLE ST
HOLYOKE MA
01040-5144
US

V. Phone/Fax

Practice location:
  • Phone: 413-420-2144
  • Fax: 413-540-0957
Mailing address:
  • Phone: 413-420-2144
  • Fax: 413-540-0957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1647
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: