MEDICARE: ANGELIQUE GOUIN RDN

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	ND12075	FL

General Provider Information

NPI Number	:	1659064970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELIQUE GOUIN RDN

Provider Business Mailing Address
First Line	:	2200 N AUSTRALIAN AVE APT S617
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-5658
Country	:	US
Telephone Number	:	561-260-6606
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 N AUSTRALIAN AVE APT S617
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-5658
Country	:	US
Telephone Number	:	561-260-6606
Fax Number	:

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

Provider Enumeration Date	:	06/01/2023
Last Update Date	:	06/01/2023

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