Provider Demographics
NPI:1689210411
Name:DIDIO, KRISTINA C (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:C
Last Name:DIDIO
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3651 JASMINE AVE APT 210
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-5398
Mailing Address - Country:US
Mailing Address - Phone:315-350-7524
Mailing Address - Fax:
Practice Address - Street 1:1900 E SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-2725
Practice Address - Country:US
Practice Address - Phone:323-277-7678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86118906133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty