Provider Demographics
NPI:1629398359
Name:MLADENOVA, DENITZA ISSAEVA (RD, LD/N)
Entity type:Individual
Prefix:MRS
First Name:DENITZA
Middle Name:ISSAEVA
Last Name:MLADENOVA
Suffix:
Gender:F
Credentials: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 1:3225 UNIVERSITY BLVD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-2762
Mailing Address - Country:US
Mailing Address - Phone:904-253-1520
Mailing Address - Fax:
Practice Address - Street 1:3225 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-2762
Practice Address - Country:US
Practice Address - Phone:904-253-1520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 5731133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered