Individual
DANA MARIA HERAZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD,LD,CDE
Contact information
Practice address
251 N BAYOU ST, MOBILE, AL 36603-5827
(251) 690-8847
(251) 544-2188
Mailing address
251 N BAYOU ST, MOBILE, AL 36603-5827
(251) 690-8847
(251) 544-2188
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
667852
AL
133V00000X
Registered Dietitian
LD 131
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011846
MEDICARE GROUP PAYEE NUMBER
AL
01
—
1063439065
NPI GROUP PAYEE NUMBER
AL
05
—
630000013
—
AL
Enumeration date
03/01/2007
Last updated
05/05/2014
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