Provider Demographics
NPI:1093381535
Name:MORAN, MARIA (RDN, CD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7060 LINCOLN PARK WAY SW APT 406
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-2084
Mailing Address - Country:US
Mailing Address - Phone:626-893-9631
Mailing Address - Fax:
Practice Address - Street 1:1100 NE 45TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4683
Practice Address - Country:US
Practice Address - Phone:206-926-9087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADI60503413OtherDEPARTMENT OF HEALTH