MEDICARE: MRS. KAREN GERONYMO RDLD/N

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	ND 1412	FL

General Provider Information

NPI Number	:	1801040373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAREN GERONYMO RDLD/N

Provider Business Mailing Address
First Line	:	6423 COLLINS AVE APT 1706
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-4643
Country	:	US
Telephone Number	:	305-298-2053
Fax Number	:

Provider Business Practice Location Address
First Line	:	6423 COLLINS AVE APT 1706
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-4643
Country	:	US
Telephone Number	:	305-298-2053
Fax Number	:

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

Provider Enumeration Date	:	11/11/2008
Last Update Date	:	11/11/2008

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