Healthcare Provider Details

I. General information

NPI: 1205968872
Provider Name (Legal Business Name): MILAGROS GATMAYTAN PLAGATA R.D.L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14480 CAVES RD
NOVELTY OH
44072-9505
US

IV. Provider business mailing address

14480 CAVES RD
NOVELTY OH
44072-9505
US

V. Phone/Fax

Practice location:
  • Phone: 440-338-1523
  • Fax: 440-338-1523
Mailing address:
  • Phone: 440-338-1523
  • Fax: 440-338-1523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2159LD
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: