Provider Demographics
NPI:1134927346
Name:DE LA CERA, MAURICIO (MS RD LD/N)
Entity type:Individual
Prefix:
First Name:MAURICIO
Middle Name:
Last Name:DE LA CERA
Suffix:
Gender:
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 1:5344 N SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2609
Mailing Address - Country:US
Mailing Address - Phone:561-816-8208
Mailing Address - Fax:
Practice Address - Street 1:5344 N SPRINGS WAY
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-2609
Practice Address - Country:US
Practice Address - Phone:561-816-8208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-04
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1063195133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered