Provider Demographics
NPI:1386019446
Name:ROSAS-ALVAREZ, MAURICIO (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:MAURICIO
Middle Name:
Last Name:ROSAS-ALVAREZ
Suffix:
Gender:M
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 S SALCEDO ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-1835
Mailing Address - Country:US
Mailing Address - Phone:818-631-0752
Mailing Address - Fax:
Practice Address - Street 1:1309 S SALCEDO ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-1835
Practice Address - Country:US
Practice Address - Phone:818-631-0752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2595133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered