Provider Demographics
NPI:1013987775
Name:ROSE, PAULINA (RD CDN)
Entity Type:Individual
Prefix:
First Name:PAULINA
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:RD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9805
Mailing Address - Street 2:300 GEORGE ST 6TH FLOOR
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06536-0805
Mailing Address - Country:US
Mailing Address - Phone:203-785-7998
Mailing Address - Fax:
Practice Address - Street 1:2 CHURCH ST S
Practice Address - Street 2:SUITE 511
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1717
Practice Address - Country:US
Practice Address - Phone:203-764-9199
Practice Address - Fax:203-764-9149
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000487133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered