Provider Demographics
NPI:1780402065
Name:CUCALON, CARMEN REBECCA (RD,LDN)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:REBECCA
Last Name:CUCALON
Suffix:
Gender:F
Credentials:RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 15TH ST APT 222
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3970
Mailing Address - Country:US
Mailing Address - Phone:401-284-8626
Mailing Address - Fax:
Practice Address - Street 1:40 DUKE MEDICINE CIRCLE, ROOM 015 PURPLE ZONE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710
Practice Address - Country:US
Practice Address - Phone:919-668-2290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL007415133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered