Provider Demographics
NPI:1558757823
Name:RICCOMBENI, MARIA EUGENIA (RD, LD/N)
Entity Type:Individual
Prefix:
First Name:MARIA EUGENIA
Middle Name:
Last Name:RICCOMBENI
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12755 SW 132ND TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6290
Mailing Address - Country:US
Mailing Address - Phone:786-614-9280
Mailing Address - Fax:
Practice Address - Street 1:12755 SW 132ND TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6290
Practice Address - Country:US
Practice Address - Phone:786-592-1520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7293133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered