MEDICARE: MRS. ANGELA MARIA PLACERES RDN, LDN

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	3095	FL

General Provider Information

NPI Number	:	1417414236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA MARIA PLACERES RDN, LDN

Provider Business Mailing Address
First Line	:	11600 SW 100TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-2522
Country	:	US
Telephone Number	:	786-596-3467
Fax Number	:

Provider Business Practice Location Address
First Line	:	12420 SW 127TH AVE FL 2
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-6596
Country	:	US
Telephone Number	:	786-596-3467
Fax Number	:

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

Provider Enumeration Date	:	02/28/2019
Last Update Date	:	02/28/2019

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