Organization
TEACHING FENIX RDN CAFE LLC
Active
Parent organization
CYNTHIA L LOPEZ-PETTORINO SOLE MBR
Organization subpart
Yes
Provider details
NPI number
Legal business name
CYNTHIA L LOPEZ-PETTORINO SOLE MBR
Authorized official
MS. CYNTHIA L LOPEZ-PETTORINO RDN, CDE (OWNER, PROVIDER, SINGLE MEMBER LLC)
(973) 206-2130
Entity
Organization
Contact information
Practice address
100 ENTERPRISE DR STE 301, ROCKAWAY, NJ 07866-2129
(973) 206-2130
(973) 385-1650
Mailing address
100 ENTERPRISE DR STE 301, ROCKAWAY, NJ 07866-2129
(973) 206-2130
(973) 385-1650
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1376849117
TYPE 1 NPI FOR CYNTHIA L LOPEZ-PETTORINO
NJ
Enumeration date
03/03/2020
Last updated
10/20/2023
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