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General NPI Number Information
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NPI Number | 1134190671
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Entity Type | Individual
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Provider Name | MARIA CORAZON COE MSRD CDN
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Gender | Female
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Dates
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Enumeration Date | 02/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4305 48TH AVE
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City | WOODSIDE
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State | NY
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Zip | 11377-6241
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Country | US
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Telephone | 718-706-1009
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Fax | 718-706-0771
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Provider Business Mailing Address
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Address Line | 3224 32ND ST
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City | LONG ISLAND CITY
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State | NY
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Zip | 11106-2645
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Country | US
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Telephone | 718-626-5393
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Fax | 212-219-3601
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 0039351
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License Number State | NY
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