Provider Demographics
NPI:1760969034
Name:RAFIE, CARLIN (PHD, RD)
Entity Type:Individual
Prefix:
First Name:CARLIN
Middle Name:
Last Name:RAFIE
Suffix:
Gender:F
Credentials:PHD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 WALLACE HALL (0430) 295 WEST CAMPUS DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24061-0001
Mailing Address - Country:US
Mailing Address - Phone:540-231-3162
Mailing Address - Fax:540-231-3916
Practice Address - Street 1:321 WALLACE HALL (0430) 295 WEST CAMPUS DRIVE
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24061-0001
Practice Address - Country:US
Practice Address - Phone:540-231-3162
Practice Address - Fax:540-231-3916
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2019-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
720210133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174H00000XOther Service ProvidersHealth Educator