Provider Demographics
NPI:1609014109
Name:BONEFONT, ROSSIE E (MPH, RD,LND)
Entity Type:Individual
Prefix:
First Name:ROSSIE
Middle Name:E
Last Name:BONEFONT
Suffix:
Gender:F
Credentials:MPH, RD,LND
Other - Prefix:
Other - First Name:ROSSIE
Other - Middle Name:E
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPH, RD,LND
Mailing Address - Street 1:PO BOX 616788
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32861-6788
Mailing Address - Country:US
Mailing Address - Phone:407-447-7105
Mailing Address - Fax:407-770-0594
Practice Address - Street 1:2285 S SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-2703
Practice Address - Country:US
Practice Address - Phone:407-282-8200
Practice Address - Fax:407-728-2801
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5178133N00000X
PR818133N00000X
IL706357133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLND5178OtherNUTRICIONIST LICENSE
FL706357OtherDIETICIAN CERTIFICATE
FLND5178OtherNUTRICIONIST LICENSE