Healthcare Provider Details

I. General information

NPI: 1508223439
Provider Name (Legal Business Name): MONICA GRIMALDI R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2016
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 PONCE DE LEON BLVD
CORAL GABLES FL
33146-2513
US

IV. Provider business mailing address

5555 PONCE DE LEON BLVD
CORAL GABLES FL
33146-2513
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-3636
  • Fax: 305-243-6575
Mailing address:
  • Phone: 305-243-3636
  • Fax: 305-243-6575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberND 7628
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberND7628
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND7628
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: