MEDICARE: MRS. CATHERINE CLARK-REYES 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	133N00000X	Nutritionist	ND0003396	FL
2	133NN1002X	Nutrition Education Nutritionist	ND0003396	FL
3	133V00000X	Registered Dietitian	ND0003396	FL
4	133VN1004X	Pediatric Nutrition Registered Dietitian	ND0003396	FL
5	133VN1005X	Renal Nutrition Registered Dietitian	ND0003396	FL
6	133VN1006X	Metabolic Nutrition Registered Dietitian	ND0003396	FL

General Provider Information

NPI Number	:	1437421575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CATHERINE CLARK-REYES RD, LD/N

Provider Business Mailing Address
First Line	:	PO BOX 557083
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33255-7083
Country	:	US
Telephone Number	:	305-812-2186
Fax Number	:	305-812-2186

Provider Business Practice Location Address
First Line	:	6808 SW 81ST ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33143-7708
Country	:	US
Telephone Number	:	305-812-2186
Fax Number	:	305-812-2186

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

Provider Enumeration Date	:	02/06/2012
Last Update Date	:	02/06/2012

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