Provider Demographics
NPI:1043691215
Name:VERA, KRISTINA (RD)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:VERA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 1ST ST SE
Mailing Address - Street 2:APT 914
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-3392
Mailing Address - Country:US
Mailing Address - Phone:512-590-1585
Mailing Address - Fax:
Practice Address - Street 1:1011 1ST ST SE
Practice Address - Street 2:APT 914
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-3392
Practice Address - Country:US
Practice Address - Phone:512-590-1585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-14
Last Update Date:2015-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDI100000720133V00000X
MDDX3735133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered