NPI 1588089684

Jorge a Prada, CNS

Practitioner Dietary Manager Clarkston, MI

Practice location

Address: 5885 S Main St Suite 6b, Clarkston, MI 48346-2981
Phone: (248) 707-6367
Fax: (248) 707-6233

Registered specialties

Dietary Manager Primary

Dietary & Nutritional Service Providers Taxonomy 132700000X Licence 12017 (IL)

Other Dietary Manager providers in Michigan →

Registry record

NPI: 1588089684
Entity type: Individual
Sex (as registered): Male
NPI issued: 26 Feb 2014
Record last updated: 26 Feb 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.