Provider Demographics
NPI:1750652343
Name:CIORCIARI, MARISSA (MS, RD, LD/N)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:CIORCIARI
Suffix:
Gender:F
Credentials:MS, RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 NE 190TH ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3206
Mailing Address - Country:US
Mailing Address - Phone:305-619-2780
Mailing Address - Fax:
Practice Address - Street 1:3580 MYSTIC POINTE DR STE 1B
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2554
Practice Address - Country:US
Practice Address - Phone:305-619-2780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004079133V00000X
FLND 6021133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered