MEDICARE: CRISTINA M GRULLON MS, RD, LD, CDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	ND4140	FL

General Provider Information

NPI Number	:	1528279882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINA M GRULLON MS, RD, LD, CDE

Provider Business Mailing Address
First Line	:	3968 SW 156TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-5420
Country	:	US
Telephone Number	:	305-724-6733
Fax Number	:

Provider Business Practice Location Address
First Line	:	9250 W FLAGLER ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33174-3414
Country	:	US
Telephone Number	:	305-552-2467
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	07/08/2007

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