Provider Demographics
NPI:1942415989
Name:AGUIRRE, CAROL (MS RDLDN)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:
Last Name:AGUIRRE
Suffix:
Gender:F
Credentials:MS RDLDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 BAYSHORE DR APT 705
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3991
Mailing Address - Country:US
Mailing Address - Phone:954-298-1829
Mailing Address - Fax:
Practice Address - Street 1:2598 E SUNRISE BLVD STE 210A
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3230
Practice Address - Country:US
Practice Address - Phone:954-603-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 4824133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered