Provider Demographics
NPI:1053669150
Name:DR PAT THE RD LLC
Entity Type:Organization
Organization Name:DR PAT THE RD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:JOLANDA
Authorized Official - Last Name:BRATHWAITE
Authorized Official - Suffix:
Authorized Official - Credentials:EDD MPH RD LDN
Authorized Official - Phone:786-234-2184
Mailing Address - Street 1:PO BOX 972371
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33197-2371
Mailing Address - Country:US
Mailing Address - Phone:786-234-2184
Mailing Address - Fax:888-776-0842
Practice Address - Street 1:12267 SW 251ST TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-5926
Practice Address - Country:US
Practice Address - Phone:786-234-2184
Practice Address - Fax:888-776-0842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4594133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty