Provider Demographics
NPI:1033848395
Name:BRAIN URRUNAGA, CARMEN TERESA (RDN, LDN)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:TERESA
Last Name:BRAIN URRUNAGA
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 LANDINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-1114
Mailing Address - Country:US
Mailing Address - Phone:954-290-4102
Mailing Address - Fax:
Practice Address - Street 1:291 LANDINGS BLVD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33327-1114
Practice Address - Country:US
Practice Address - Phone:954-290-4102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4255133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered