Healthcare Provider Details

I. General information

NPI: 1902415177
Provider Name (Legal Business Name): TANIA MARIE CUADRA RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOFFMAN ST
AUBURN NY
13021-2157
US

IV. Provider business mailing address

57 FINNERTY RD
WESTDALE NY
13483-1300
US

V. Phone/Fax

Practice location:
  • Phone: 315-704-0319
  • Fax:
Mailing address:
  • Phone: 650-580-1126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86053342
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86053342
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: