Provider Demographics
NPI:1114516119
Name:KEA SCHWARZ FUNCTIONAL NUTRITION
Entity Type:Organization
Organization Name:KEA SCHWARZ FUNCTIONAL NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHWARZ
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:305-332-4148
Mailing Address - Street 1:2913 HUNTERS HILL E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-3819
Mailing Address - Country:US
Mailing Address - Phone:305-332-4148
Mailing Address - Fax:
Practice Address - Street 1:2913 HUNTERS HILL E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-3819
Practice Address - Country:US
Practice Address - Phone:305-332-4148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty