Healthcare Provider Details

I. General information

NPI: 1215345889
Provider Name (Legal Business Name): MARIANA ARELI ANAYA R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 07/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LENOIR HALL SORORITY ROW, DEPARTMENT OF NUTRITION & HOSPITALITY MANAGEMENT
UNIVERSITY MS
38677-1848
US

IV. Provider business mailing address

110 LENOIR HALL SORORITY ROW, DEPARTMENT OF NUTRITION & HOSPITALITY MANAGEMENT
UNIVERSITY MS
38677-1848
US

V. Phone/Fax

Practice location:
  • Phone: 662-915-2081
  • Fax: 662-915-7039
Mailing address:
  • Phone: 662-915-2081
  • Fax: 662-915-7039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD1645
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: