MEDICARE: NICOLE BOON LOPES RD, LD/N

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	9850	FL
2	133V00000X	Registered Dietitian	1096920	FL

General Provider Information

NPI Number	:	1174203111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE BOON LOPES RD, LD/N

Provider Business Mailing Address
First Line	:	50 MENORES AVE APT 630
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4043
Country	:	US
Telephone Number	:	787-944-3134
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 FOREST HILL BLVD BLDG E
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5813
Country	:	US
Telephone Number	:	561-468-2230
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2023
Last Update Date	:	07/24/2023

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