Healthcare Provider Details

I. General information

NPI: 1588117667
Provider Name (Legal Business Name): ANA CHRISTINA GRIMSLEY RDN, LD/N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANA CHRISTINA ALFONSO RDN

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6478 MOSELEY ST
HOLLYWOOD FL
33024
US

IV. Provider business mailing address

6478 MOSELEY ST
HOLLYWOOD FL
33024-4109
US

V. Phone/Fax

Practice location:
  • Phone: 305-498-0995
  • Fax:
Mailing address:
  • Phone: 305-498-0995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: