MEDICARE: MARIA EUGENIA RICCOMBENI 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	ND7293	FL

General Provider Information

NPI Number	:	1558757823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA EUGENIA RICCOMBENI RD, LD/N

Provider Business Mailing Address
First Line	:	12755 SW 132ND TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-6290
Country	:	US
Telephone Number	:	786-614-9280
Fax Number	:

Provider Business Practice Location Address
First Line	:	12755 SW 132ND TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-6290
Country	:	US
Telephone Number	:	786-592-1520
Fax Number	:

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

Provider Enumeration Date	:	04/13/2015
Last Update Date	:	10/21/2021

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