Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 001898 | CT |
NPI | 1225388069 |
---|---|
Provider Name | Dr. Grisell Viviana Paz |
First Address | Bridgeport, CT 06604-1800 |
Second Address | Stamford, CT 06905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2012 |
Last Update Date | 19/09/2012 |