Provider Demographics
NPI:1689381295
Name:CUCCIA, MARIA ELIZABETH (RDN)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELIZABETH
Last Name:CUCCIA
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ELIZABETH
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:1199 N BROADWAY ST APT 158
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-0009
Mailing Address - Country:US
Mailing Address - Phone:903-267-0887
Mailing Address - Fax:
Practice Address - Street 1:1935 MEDICAL DISTRICT DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7701
Practice Address - Country:US
Practice Address - Phone:214-456-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86337133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered