Provider Demographics
NPI:1295414639
Name:HENAO, KATERIN (RDN)
Entity type:Individual
Prefix:
First Name:KATERIN
Middle Name:
Last Name:HENAO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SE 3RD AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-6418
Mailing Address - Country:US
Mailing Address - Phone:917-564-4602
Mailing Address - Fax:
Practice Address - Street 1:400 SE 3RD AVE APT 102
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-6418
Practice Address - Country:US
Practice Address - Phone:917-564-4602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12256133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered