Healthcare Provider Details

I. General information

NPI: 1376793893
Provider Name (Legal Business Name): HEALTH NUT NUTRITION & WELLNESS CONSULTANTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11001 SW 26TH ST
MIAMI FL
33165-2303
US

IV. Provider business mailing address

11001 SW 26TH ST
MIAMI FL
33165-2303
US

V. Phone/Fax

Practice location:
  • Phone: 305-490-5070
  • Fax: 305-553-8563
Mailing address:
  • Phone: 305-490-5070
  • Fax: 305-553-8563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND 5394
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberND 5394
License Number StateFL

VIII. Authorized Official

Name: MELISSA MARIA BERROCAL
Title or Position: PRESIDENT
Credential: RD, MS
Phone: 305-490-5070