Provider Demographics
NPI:1831911353
Name:GARZON, DIEGO ALEJANDRO (RD)
Entity type:Individual
Prefix:MR
First Name:DIEGO
Middle Name:ALEJANDRO
Last Name:GARZON
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 SW 28TH LN APT 805
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-3875
Mailing Address - Country:US
Mailing Address - Phone:407-580-7007
Mailing Address - Fax:
Practice Address - Street 1:2900 SW 28TH LN APT 805
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-3875
Practice Address - Country:US
Practice Address - Phone:407-580-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-26
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11052133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered