Healthcare Provider Details

I. General information

NPI: 1376516997
Provider Name (Legal Business Name): LINDA M. ROBERTO MNT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 01/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 E MORELAND AVE SUITE 100
PHILADELPHIA PA
19118-3541
US

IV. Provider business mailing address

10 E MORELAND AVE SUITE 100
PHILADELPHIA PA
19118-3541
US

V. Phone/Fax

Practice location:
  • Phone: 267-385-5538
  • Fax: 267-437-3176
Mailing address:
  • Phone: 267-385-5538
  • Fax: 267-437-3176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberDN000560
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: