Healthcare Provider Details

I. General information

NPI: 1285210716
Provider Name (Legal Business Name): CARI VERDE MS, CNS, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 TECH RD STE 102
SILVER SPRING MD
20904-7871
US

IV. Provider business mailing address

4824 YORKTOWN BLVD
HONOLULU HI
96818-5058
US

V. Phone/Fax

Practice location:
  • Phone: 301-622-2722
  • Fax:
Mailing address:
  • Phone: 614-372-9872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDX4770
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: