Provider Demographics
NPI:1508685363
Name:INFANTE MOURE, MASSIEL (RDN, LDN)
Entity type:Individual
Prefix:
First Name:MASSIEL
Middle Name:
Last Name:INFANTE MOURE
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8305 HAMMOCKS BLVD APT 5114
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-4170
Mailing Address - Country:US
Mailing Address - Phone:239-745-0393
Mailing Address - Fax:
Practice Address - Street 1:8305 HAMMOCKS BLVD APT 5114
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-4170
Practice Address - Country:US
Practice Address - Phone:239-745-0393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND11768133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered