Provider Demographics
NPI:1356467971
Name:PERDOMO, MALENA E (RDN, CDE)
Entity Type:Individual
Prefix:
First Name:MALENA
Middle Name:E
Last Name:PERDOMO
Suffix:
Gender:F
Credentials:RDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 S HONEY WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-1914
Mailing Address - Country:US
Mailing Address - Phone:303-915-0874
Mailing Address - Fax:
Practice Address - Street 1:1190 S HONEY WAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1914
Practice Address - Country:US
Practice Address - Phone:303-915-0874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1861161507OtherNPPES