Provider Demographics
NPI:1356513865
Name:CORA, WAIKI VICKY (RD)
Entity type:Individual
Prefix:
First Name:WAIKI
Middle Name:VICKY
Last Name:CORA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:WAIKI
Other - Middle Name:VICKY
Other - Last Name:LEUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:317 6TH AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-4108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8270 WOODLAND CENTER BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2401
Practice Address - Country:US
Practice Address - Phone:305-449-9219
Practice Address - Fax:515-864-0259
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND10389133V00000X
NMLD1583133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI933602OtherCDR CERTIFICATION