Provider Demographics
NPI:1053724492
Name:DEL RIO, JENNIFER JOSEFINA (RD)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JOSEFINA
Last Name:DEL RIO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2322 E 22ND ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-3176
Mailing Address - Country:US
Mailing Address - Phone:216-592-2819
Mailing Address - Fax:216-592-2811
Practice Address - Street 1:2322 E 22ND ST
Practice Address - Street 2:SUITE 207
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3176
Practice Address - Country:US
Practice Address - Phone:216-592-2819
Practice Address - Fax:216-592-2811
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7134133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered