Healthcare Provider Details

I. General information

NPI: 1942954110
Provider Name (Legal Business Name): THE HAITIAN NUTRITIONIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7145 SW 42ND TER
MIAMI FL
33155-4605
US

IV. Provider business mailing address

7145 SW 42ND TER
MIAMI FL
33155-4605
US

V. Phone/Fax

Practice location:
  • Phone: 786-205-7586
  • Fax: 786-822-5533
Mailing address:
  • Phone: 786-377-4740
  • Fax: 786-822-5533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: OLGUYNE FERNANDEZ-FRAGA
Title or Position: REGISTERED DIETITIAN
Credential:
Phone: 786-377-4740