Provider Demographics
NPI:1376205104
Name:MORITZ, DAINA (MS, RDN)
Entity Type:Individual
Prefix:
First Name:DAINA
Middle Name:
Last Name:MORITZ
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11431 NW 9TH TER
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-5004
Mailing Address - Country:US
Mailing Address - Phone:314-681-5350
Mailing Address - Fax:
Practice Address - Street 1:11431 NW 9TH TER
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-5004
Practice Address - Country:US
Practice Address - Phone:314-681-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLD2636133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered