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General NPI Number Information
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NPI Number | 1992204564
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Entity Type | Organization
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Legal Business Name | JACINTA NUTRITION AND DIABETES EDUCATION SERVICES LLC
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Dates
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Enumeration Date | 02/08/2018
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Last Update Date | 02/08/2018
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Provider Practice Location Address
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Address Line | 21 WEST RD STE 103
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City | BALTIMORE
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State | MD
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Zip | 21204-2307
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Country | US
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Telephone | 443-652-3674
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Fax | 443-895-4165
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Provider Business Mailing Address
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Address Line | 21 WEST RD STE 103
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City | BALTIMORE
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State | MD
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Zip | 21204-2307
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Country | US
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Telephone | 443-652-3674
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Fax | 443-895-4165
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Authorized Official
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Title or Position | QUALITY COORDINATOR
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Name | MS. CATHERINE C GENTHNER
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Credential | MAS, RDN, LDN, CDE
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Telephone | 443-652-3674
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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 | D01213
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License Number State | MD
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