Provider Demographics
NPI:1891760336
Name:BERTOT-CASH, MARITZA (DIETITIAN)
Entity Type:Individual
Prefix:
First Name:MARITZA
Middle Name:
Last Name:BERTOT-CASH
Suffix:
Gender:F
Credentials:DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4135 LAND O LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-4425
Mailing Address - Country:US
Mailing Address - Phone:813-558-5173
Mailing Address - Fax:813-558-5189
Practice Address - Street 1:4135 LAND O LAKES BLVD
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-4425
Practice Address - Country:US
Practice Address - Phone:813-558-5173
Practice Address - Fax:813-558-5189
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND907133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4688ZMedicare ID - Type Unspecified