Provider Demographics
NPI:1659976819
Name:PENUELA, NORMA C (RD)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:C
Last Name:PENUELA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14166 S CYPRESS COVE CIR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-6739
Mailing Address - Country:US
Mailing Address - Phone:305-519-5046
Mailing Address - Fax:
Practice Address - Street 1:14166 S CYPRESS COVE CIR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33325-6739
Practice Address - Country:US
Practice Address - Phone:305-519-5046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4512133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered