Healthcare Provider Details

I. General information

NPI: 1700077955
Provider Name (Legal Business Name): MARGARITA SIERRA MBA, RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 E RANDOLPH AVE
MINE HILL NJ
07803-3070
US

IV. Provider business mailing address

389 E RANDOLPH AVE
MINE HILL NJ
07803-3070
US

V. Phone/Fax

Practice location:
  • Phone: 862-707-8404
  • Fax: 973-328-1432
Mailing address:
  • Phone: 862-707-8404
  • Fax: 973-328-1432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number877964
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: