Provider Demographics
NPI:1336845965
Name:ORREGO, TATIANA MARIA
Entity Type:Individual
Prefix:MRS
First Name:TATIANA
Middle Name:MARIA
Last Name:ORREGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:698 LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3546
Mailing Address - Country:US
Mailing Address - Phone:305-206-4183
Mailing Address - Fax:
Practice Address - Street 1:698 LAKE BLVD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3546
Practice Address - Country:US
Practice Address - Phone:305-206-4183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11419133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered