Provider Demographics
NPI:1376849117
Name:LOPEZ-PETTORINO, CYNTHIA L (RDN, CDCES)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:L
Last Name:LOPEZ-PETTORINO
Suffix:
Gender:F
Credentials:RDN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ENTERPRISE DR STE 301
Mailing Address - Street 2:ATTENTION: TEACHING FENIX RDN CAFE LLC
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-2129
Mailing Address - Country:US
Mailing Address - Phone:973-206-2130
Mailing Address - Fax:973-385-1650
Practice Address - Street 1:100 ENTERPRISE DR STE 301
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-2129
Practice Address - Country:US
Practice Address - Phone:973-206-2130
Practice Address - Fax:973-385-1650
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ848821133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered