Healthcare Provider Details

I. General information

NPI: 1942066683
Provider Name (Legal Business Name): NATASHA JADE YEPEZ-BERKELEY RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4306 ALTON RD FL 2
MIAMI BEACH FL
33140-2840
US

IV. Provider business mailing address

8522 SW 103RD AVE
MIAMI FL
33173-3957
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2202
  • Fax: 305-674-2863
Mailing address:
  • Phone: 305-610-8586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: