Provider Demographics
NPI:1447681226
Name:PEREZ, MARCELINA OFILIA (RDN, LD)
Entity type:Individual
Prefix:
First Name:MARCELINA
Middle Name:OFILIA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 S IRONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-6402
Mailing Address - Country:US
Mailing Address - Phone:956-867-5014
Mailing Address - Fax:
Practice Address - Street 1:1314 S IRONWOOD ST
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-6402
Practice Address - Country:US
Practice Address - Phone:956-867-5014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82612133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered