Healthcare Provider Details

I. General information

NPI: 1780825844
Provider Name (Legal Business Name): KARA CUCINOTTA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARA BOWLEY

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

167 POINT ST
PROVIDENCE RI
02903-4771
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-6966
  • Fax: 401-444-5462
Mailing address:
  • Phone: 401-444-5640
  • Fax: 401-444-5642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN00639
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: