Provider Demographics
NPI:1184229841
Name:MIAMI DIETITIANS GROUP INC
Entity Type:Organization
Organization Name:MIAMI DIETITIANS GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:EUGENIA
Authorized Official - Last Name:RICCOMBENI
Authorized Official - Suffix:
Authorized Official - Credentials:RD LD N
Authorized Official - Phone:786-592-1520
Mailing Address - Street 1:11413 SW 246TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-4655
Mailing Address - Country:US
Mailing Address - Phone:786-592-1520
Mailing Address - Fax:
Practice Address - Street 1:11413 SW 246TH TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-4655
Practice Address - Country:US
Practice Address - Phone:786-592-1520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7293OtherND7293