Healthcare Provider Details

I. General information

NPI: 1417026006
Provider Name (Legal Business Name): KARON M RZAD RD CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 NW 12TH AVE C035
MIAMI FL
33136-1002
US

IV. Provider business mailing address

PO BOX 776
KEY WEST FL
33041-0776
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-8885
  • Fax: 305-243-5233
Mailing address:
  • Phone: 305-243-8885
  • Fax: 305-243-5233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberND 2445
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: