Healthcare Provider Details

I. General information

NPI: 1336564269
Provider Name (Legal Business Name): ANA LLINAS SOBRINO RDN, CSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2014
Last Update Date: 07/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

672 CREEKRIDGE RD
AIKEN SC
29803-8664
US

IV. Provider business mailing address

672 CREEKRIDGE RD
AIKEN SC
29803-8664
US

V. Phone/Fax

Practice location:
  • Phone: 505-506-7009
  • Fax:
Mailing address:
  • Phone: 505-506-7009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1079
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: