Provider Demographics
NPI:1700496361
Name:GONZALEZ, CRISTINA (RD, CDN)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 MORGAN ST APT 5J
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5405
Mailing Address - Country:US
Mailing Address - Phone:203-824-9182
Mailing Address - Fax:
Practice Address - Street 1:83 MORGAN ST APT 5J
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5405
Practice Address - Country:US
Practice Address - Phone:203-824-9182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT86069817133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered