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General NPI Number Information
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NPI Number | 1053669150
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Entity Type | Organization
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Legal Business Name | DR PAT THE RD LLC
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Dates
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Enumeration Date | 08/21/2012
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Last Update Date | 08/21/2012
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Provider Practice Location Address
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Address Line | 12267 SW 251ST TER
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City | HOMESTEAD
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State | FL
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Zip | 33032-5926
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Country | US
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Telephone | 786-234-2184
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Fax | 888-776-0842
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Provider Business Mailing Address
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Address Line | PO BOX 972371
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City | MIAMI
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State | FL
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Zip | 33197-2371
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Country | US
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Telephone | 786-234-2184
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Fax | 888-776-0842
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PATRICIA JOLANDA BRATHWAITE
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Credential | EDD MPH RD LDN
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Telephone | 786-234-2184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | ND4594
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | ND4594
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License Number State | FL
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