Provider Demographics
NPI:1982856605
Name:MOLENO, MARIA CYNTHIA M (RD,CSO)
Entity Type:Individual
Prefix:
First Name:MARIA CYNTHIA
Middle Name:M
Last Name:MOLENO
Suffix:
Gender:F
Credentials:RD,CSO
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:M
Other - Last Name:MOLENO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, CSO
Mailing Address - Street 1:12717 OTTOMAN ST
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-4267
Mailing Address - Country:US
Mailing Address - Phone:323-459-7994
Mailing Address - Fax:
Practice Address - Street 1:23929 MCBEANPKWY
Practice Address - Street 2:SUITE #110
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355
Practice Address - Country:US
Practice Address - Phone:323-459-7994
Practice Address - Fax:661-255-8478
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA924712133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered