Provider Demographics
NPI:1952808669
Name:CAMARASA, SUSANA ANALIA (MS)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:ANALIA
Last Name:CAMARASA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14928 OLD VERMILLION DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5337
Mailing Address - Country:US
Mailing Address - Phone:704-248-0954
Mailing Address - Fax:
Practice Address - Street 1:14928 OLD VERMILLION DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5337
Practice Address - Country:US
Practice Address - Phone:704-248-0954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education