Provider Demographics
NPI:1508223439
Name:GRIMALDI, MONICA (RD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:GRIMALDI
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 1:5555 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2513
Mailing Address - Country:US
Mailing Address - Phone:305-243-3636
Mailing Address - Fax:305-243-6575
Practice Address - Street 1:5555 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2513
Practice Address - Country:US
Practice Address - Phone:305-243-3636
Practice Address - Fax:305-243-6575
Is Sole Proprietor?:No
Enumeration Date:2016-01-22
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 7628133VN1004X
FLND76282080P0205X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology