Provider Demographics
NPI:1114287851
Name:JARAMILLO LOPEZ, ELIZABETH (RD, LD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:JARAMILLO LOPEZ
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3451 VIA BRISA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-9620
Mailing Address - Country:US
Mailing Address - Phone:575-491-2684
Mailing Address - Fax:
Practice Address - Street 1:3451 VIA BRISA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-9620
Practice Address - Country:US
Practice Address - Phone:575-491-2684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-28
Last Update Date:2012-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD0661133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered