Provider Demographics
NPI:1689739831
Name:ROSS, KATALIN M (RD)
Entity Type:Individual
Prefix:
First Name:KATALIN
Middle Name:M
Last Name:ROSS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 SW SUWANNEE DOWNS DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32024-3613
Mailing Address - Country:US
Mailing Address - Phone:386-719-9955
Mailing Address - Fax:
Practice Address - Street 1:1044 SW SUWANNEE DOWNS DR
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32024-3613
Practice Address - Country:US
Practice Address - Phone:386-719-9955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4917133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDC132AMedicare PIN
FLDC132ZMedicare PIN