Provider Demographics
NPI:1508229436
Name:CYNTHIA WIGUTOW RD LLC
Entity Type:Organization
Organization Name:CYNTHIA WIGUTOW RD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIGUTOW
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, CSO, LDN
Authorized Official - Phone:954-614-5971
Mailing Address - Street 1:3470 N 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-2659
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1150 N 35TH AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5424
Practice Address - Country:US
Practice Address - Phone:954-265-7028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation