Individual
MARISA IRENE STACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD/LDN
Contact information
Practice address
7862 NW 172ND ST, HIALEAH, FL 33015-3849
(305) 877-3079
Mailing address
7862 NW 172ND ST, HIALEAH, FL 33015-3849
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
ND8188
FL
Other
Enumeration date
05/22/2018
Last updated
05/22/2018
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