MEDICARE: CAMILA KREMER RD

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	011999	NY
2	133V00000X	Registered Dietitian	6101-73669	FL

General Provider Information

NPI Number	:	1417793902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILA KREMER RD

Provider Business Mailing Address
First Line	:	7095 POND CYPRESS CT APT 201
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-7860
Country	:	US
Telephone Number	:	239-298-6333
Fax Number	:

Provider Business Practice Location Address
First Line	:	2840 JACKSON AVE APT 16M
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-3350
Country	:	US
Telephone Number	:	239-298-6333
Fax Number	:

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

Provider Enumeration Date	:	07/03/2024
Last Update Date	:	07/03/2024

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