Healthcare Provider Details

I. General information

NPI: 1619704749
Provider Name (Legal Business Name): MATTHEW TOMA R.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 09/13/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2923 FEDERAL HWY SUITE 100
BOYNTON BEACH FL
33435
US

IV. Provider business mailing address

2923 FEDERAL HWY SUITE 100
BOYNTON BEACH FL
33435
US

V. Phone/Fax

Practice location:
  • Phone: 561-752-0100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND9598
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: