Provider Demographics
NPI:1245510809
Name:BRAND, GENINE FAE (RD)
Entity type:Individual
Prefix:
First Name:GENINE
Middle Name:FAE
Last Name:BRAND
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 1:8000 SW 160TH ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-3761
Mailing Address - Country:US
Mailing Address - Phone:786-200-3231
Mailing Address - Fax:
Practice Address - Street 1:356 ALHAMBRA CIR
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5004
Practice Address - Country:US
Practice Address - Phone:305-445-0477
Practice Address - Fax:305-445-0958
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5921133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered