MEDICARE: MRS. KRYSTAL AMANDA RIVANI 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	86016116	CA

General Provider Information

NPI Number	:	1689367716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRYSTAL AMANDA RIVANI RDN

Provider Business Mailing Address
First Line	:	4701 N MERIDIAN AVE UNIT 702
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-2966
Country	:	US
Telephone Number	:	626-419-6490
Fax Number	:

Provider Business Practice Location Address
First Line	:	4701 N MERIDIAN AVE UNIT 702
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-2966
Country	:	US
Telephone Number	:	626-419-6490
Fax Number	:

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

Provider Enumeration Date	:	06/02/2023
Last Update Date	:	06/02/2023

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