Healthcare Provider Details

I. General information

NPI: 1871351569
Provider Name (Legal Business Name): EVA LUCY COLES RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 NW 14TH ST STE 100
MIAMI FL
33136-2112
US

IV. Provider business mailing address

1150 NW 14TH ST STE 100
MIAMI FL
33136-2112
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-7900
  • Fax:
Mailing address:
  • Phone: 305-243-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND13021
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: