MEDICARE: EVA LUCY COLES RD

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	86329478	CA

General Provider Information

NPI Number	:	1871351569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVA LUCY COLES RD

Provider Business Mailing Address
First Line	:	119 E 2ND CT
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-5106
Country	:	US
Telephone Number	:	954-895-6431
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 E 2ND CT
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-5106
Country	:	US
Telephone Number	:	954-895-6431
Fax Number	:

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

Provider Enumeration Date	:	03/08/2024
Last Update Date	:	03/08/2024

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