Provider Demographics
NPI:1396133476
Name:MICKLER, BAHIYYIH RUHA (RD/ LD)
Entity type:Individual
Prefix:MISS
First Name:BAHIYYIH
Middle Name:RUHA
Last Name:MICKLER
Suffix:
Gender:F
Credentials:RD/ LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 SALAMANCA AVE
Mailing Address - Street 2:APT 11
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3948
Mailing Address - Country:US
Mailing Address - Phone:352-213-0248
Mailing Address - Fax:
Practice Address - Street 1:230 SALAMANCA AVE
Practice Address - Street 2:APT 11
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3948
Practice Address - Country:US
Practice Address - Phone:352-213-0248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-25
Last Update Date:2014-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 6199133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered