Provider Demographics
NPI:1780118695
Name:VALDEZ-JARDINE, ROCIO (RDN)
Entity type:Individual
Prefix:
First Name:ROCIO
Middle Name:
Last Name:VALDEZ-JARDINE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11889 TOM NICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:PRINCESS ANNE
Mailing Address - State:MD
Mailing Address - Zip Code:21853-3633
Mailing Address - Country:US
Mailing Address - Phone:410-968-1200
Mailing Address - Fax:
Practice Address - Street 1:11889 TOM NICHOLS RD
Practice Address - Street 2:
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853-3633
Practice Address - Country:US
Practice Address - Phone:443-783-4561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD02117133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered