Provider Demographics
NPI:1831585793
Name:FANDINO, HAROLD
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:FANDINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7941 SW 152ND AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-3217
Mailing Address - Country:US
Mailing Address - Phone:305-302-1253
Mailing Address - Fax:
Practice Address - Street 1:7941 SW 152ND AVE APT 5
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-3217
Practice Address - Country:US
Practice Address - Phone:305-302-1253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7134133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered