Provider Demographics
NPI:1982741575
Name:MABRU, CATHERINE M (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:M
Last Name:MABRU
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23257 STATE RD 7
Mailing Address - Street 2:SUITE # 204
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-5406
Mailing Address - Country:US
Mailing Address - Phone:561-218-0550
Mailing Address - Fax:561-218-1256
Practice Address - Street 1:23257 STATE ROAD 7
Practice Address - Street 2:SUITE # 204
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-5448
Practice Address - Country:US
Practice Address - Phone:561-218-0550
Practice Address - Fax:561-218-1256
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND328133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5363777OtherAETNA
FL209876OtherAVMED
FLN0006Medicare ID - Type UnspecifiedMEDICAL NUTRITION THERAPY