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NPI Code Detail

MEDICARE: LISETTE PERAZZELLI RD

MEDICARE:   LISETTE  PERAZZELLI  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
1133V00000XRegistered DietitianND7127FL

General Provider Information

NPI Number : 1518423110
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISETTE PERAZZELLI RD
Provider Business Mailing Address
First Line : 1321 SE 5TH AVE
Second Line :
City : POMPANO BEACH
State : FL
Zip : 33060-9306
Country : US
Telephone Number : 954-661-8254
Fax Number :
Provider Business Practice Location Address
First Line : 1321 SE 5TH AVE
Second Line :
City : POMPANO BEACH
State : FL
Zip : 33060-9306
Country : US
Telephone Number : 954-661-8254
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2019
Last Update Date : 02/19/2019

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Directions to “ LISETTE PERAZZELLI RD” Practice Location

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