Provider Demographics
NPI:1508261538
Name:BROSTOW, DIANA PAULINA (PHD, MPH, RDN)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:PAULINA
Last Name:BROSTOW
Suffix:
Gender:F
Credentials:PHD, MPH, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 S LINCOLN ST
Mailing Address - Street 2:APT. 202
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4075
Mailing Address - Country:US
Mailing Address - Phone:612-232-8130
Mailing Address - Fax:
Practice Address - Street 1:664 S LINCOLN ST
Practice Address - Street 2:APT. 202
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-4075
Practice Address - Country:US
Practice Address - Phone:612-232-8130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN86062748133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered