Provider Demographics
NPI:1912626359
Name:PFUND, MARIA CECILIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CECILIA
Last Name:PFUND
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 1:1455 90TH AVE LOT A9
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32966-7513
Mailing Address - Country:US
Mailing Address - Phone:352-870-1537
Mailing Address - Fax:
Practice Address - Street 1:1455 90TH AVE LOT A9
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-7513
Practice Address - Country:US
Practice Address - Phone:352-870-1537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1007258133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered