Provider Demographics
NPI:1114396421
Name:PROANO, GABRIELA VICTORIA (MS,RD)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:VICTORIA
Last Name:PROANO
Suffix:
Gender:F
Credentials:MS,RD
Other - Prefix:
Other - First Name:GABRIELA
Other - Middle Name:VICTORIA
Other - Last Name:PROANO CAICEDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RD
Mailing Address - Street 1:517 W 31ST ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-1742
Mailing Address - Country:US
Mailing Address - Phone:954-682-7409
Mailing Address - Fax:
Practice Address - Street 1:517 W 31ST ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1742
Practice Address - Country:US
Practice Address - Phone:954-682-7409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered