Provider Demographics
NPI:1295514123
Name:ASSUMPCAO MENGARELLI, CRISTIANA (MS, RDN/LD)
Entity type:Individual
Prefix:
First Name:CRISTIANA
Middle Name:
Last Name:ASSUMPCAO MENGARELLI
Suffix:
Gender:F
Credentials:MS, RDN/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 112TH ST SW UNIT E1
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-5062
Mailing Address - Country:US
Mailing Address - Phone:786-970-1214
Mailing Address - Fax:
Practice Address - Street 1:729 112TH ST SW UNIT E1
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-5062
Practice Address - Country:US
Practice Address - Phone:786-970-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9733133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered