Provider Demographics
NPI:1538664743
Name:MENDOZA HOLMES, EUNICE (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:
Last Name:MENDOZA HOLMES
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 NW 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5102
Mailing Address - Country:US
Mailing Address - Phone:954-632-7759
Mailing Address - Fax:
Practice Address - Street 1:2575 NW 92ND AVE
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5102
Practice Address - Country:US
Practice Address - Phone:954-632-7759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6521133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered