Provider Demographics
NPI:1427221001
Name:OLIVEROS, MONINIA SIANGHIO (RD)
Entity Type:Individual
Prefix:MRS
First Name:MONINIA
Middle Name:SIANGHIO
Last Name:OLIVEROS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26906 N 21ST DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-8723
Mailing Address - Country:US
Mailing Address - Phone:623-332-5793
Mailing Address - Fax:
Practice Address - Street 1:26906 N 21ST DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-8723
Practice Address - Country:US
Practice Address - Phone:623-332-5793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
644878133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered