Provider Demographics
NPI:1982363040
Name:AGUILLON, MARISA CRUZ (RD, LD, CDCES)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:CRUZ
Last Name:AGUILLON
Suffix:
Gender:F
Credentials:RD, LD, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 S ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4006
Mailing Address - Country:US
Mailing Address - Phone:469-271-7529
Mailing Address - Fax:
Practice Address - Street 1:214 S ALEXANDER AVE
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4006
Practice Address - Country:US
Practice Address - Phone:469-271-7529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82713133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT82713OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION