Healthcare Provider Details

I. General information

NPI: 1346298783
Provider Name (Legal Business Name): RENAL NUTRITION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 FALCON RIDGE CIR
WESTON FL
33331-5015
US

IV. Provider business mailing address

3850 FALCON RIDGE CIR
WESTON FL
33331-5015
US

V. Phone/Fax

Practice location:
  • Phone: 954-389-1758
  • Fax:
Mailing address:
  • Phone: 954-389-1758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberND4188
License Number StateFL

VIII. Authorized Official

Name: MR. DANIEL THOMAS
Title or Position: REGISTERED DIETITIAN
Credential: RD/LD,N
Phone: 954-389-1758