Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CHIR007606 | GA |
NPI | 1104159342 |
---|---|
Provider Name | Dr. Dayma Rosello-Rivera |
First Address | Atlanta, GA 30328-4928 |
Second Address | Atlanta, GA 30328-4928 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2009 |
Last Update Date | 04/09/2009 |