MEDICARE: WAIKI VICKY CORA RD

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	ND10389	FL
2	133V00000X	Registered Dietitian	LD1583	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	933602	OTHER	HI	CDR CERTIFICATION

General Provider Information

NPI Number	:	1356513865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAIKI VICKY CORA RD

Provider Business Mailing Address
First Line	:	317 6TH AVE STE 400
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50309-4108
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8270 WOODLAND CENTER BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-2401
Country	:	US
Telephone Number	:	305-449-9219
Fax Number	:	515-864-0259

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

Provider Enumeration Date	:	03/25/2008
Last Update Date	:	02/28/2024

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