Provider Demographics
NPI:1548595705
Name:RISCUTA, GABRRIELA
Entity Type:Individual
Prefix:
First Name:GABRRIELA
Middle Name:
Last Name:RISCUTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11315 COMMONWEALTH DR
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2816
Mailing Address - Country:US
Mailing Address - Phone:301-230-1933
Mailing Address - Fax:301-542-0177
Practice Address - Street 1:11125 ROCKVILLE PIKE
Practice Address - Street 2:SUITE # 302
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3142
Practice Address - Country:US
Practice Address - Phone:301-230-1933
Practice Address - Fax:301-542-0177
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNU100000136133N00000X
MDDX2848133N00000X
133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist