MEDICARE: DANNIA COLETTE HENAO RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian		CA

General Provider Information

NPI Number	:	1144092693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANNIA COLETTE HENAO RDN

Provider Business Mailing Address
First Line	:	6729 SW 40TH ST
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33314-3203
Country	:	US
Telephone Number	:	954-393-5333
Fax Number	:

Provider Business Practice Location Address
First Line	:	1223 1/2 BERKELEY ST
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-1609
Country	:	US
Telephone Number	:	954-393-5333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2023
Last Update Date	:	10/27/2023

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