Provider Demographics
NPI:1457002248
Name:REGISTERED DIETITIANS CAN
Entity Type:Organization
Organization Name:REGISTERED DIETITIANS CAN
Other - Org Name:RDSCAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:O
Authorized Official - Last Name:ENOGIERU
Authorized Official - Suffix:
Authorized Official - Credentials:RD/N
Authorized Official - Phone:954-715-7233
Mailing Address - Street 1:1560 SAWGRASS CORPORATE PKWY FL 4
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2855
Mailing Address - Country:US
Mailing Address - Phone:954-715-7233
Mailing Address - Fax:954-715-7336
Practice Address - Street 1:1560 SAWGRASS CORPORATE PKWY FL 4
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2855
Practice Address - Country:US
Practice Address - Phone:954-715-7233
Practice Address - Fax:954-715-7336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty