Provider Demographics
NPI:1851703581
Name:LI, DENISE (RD, LD/N)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:LI
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 1:15760 BULL RUN RD APT 366G
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-8113
Mailing Address - Country:US
Mailing Address - Phone:305-753-8530
Mailing Address - Fax:
Practice Address - Street 1:5200 BLUE LAGOON DR
Practice Address - Street 2:SUITE 500
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-7006
Practice Address - Country:US
Practice Address - Phone:305-262-1292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6453133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered