MEDICARE: MS. MARILOU SUAREZ CASTRO 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	ND 3414	FL

General Provider Information

NPI Number	:	1851358659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARILOU SUAREZ CASTRO RDN

Provider Business Mailing Address
First Line	:	2080 CHILD ST DEPT 5000
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32214-5000
Country	:	US
Telephone Number	:	904-542-9241
Fax Number	:	904-542-7835

Provider Business Practice Location Address
First Line	:	2080 CHILD ST DEPT 5000
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32214-5000
Country	:	US
Telephone Number	:	904-542-9241
Fax Number	:	904-542-7835

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	11/02/2022

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