Provider Demographics
NPI:1578636353
Name:FARINA, CAROLE M (RD LD)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:M
Last Name:FARINA
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6838
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87504-6838
Mailing Address - Country:US
Mailing Address - Phone:505-438-2886
Mailing Address - Fax:505-438-2886
Practice Address - Street 1:2606 CALLE PRIMAVERA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-438-2886
Practice Address - Fax:505-438-2886
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM243133V00000X
R640220133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered