Provider Demographics
NPI:1982909529
Name:KOTLYAR, GALINA (MS RD LDN)
Entity Type:Individual
Prefix:MRS
First Name:GALINA
Middle Name:
Last Name:KOTLYAR
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18555 COLLINS AVE
Mailing Address - Street 2:SUITE 100-177
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2403
Mailing Address - Country:US
Mailing Address - Phone:561-628-6405
Mailing Address - Fax:270-596-4457
Practice Address - Street 1:18555 COLLINS AVE
Practice Address - Street 2:SUITE 100-177 INTRNT
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-2403
Practice Address - Country:US
Practice Address - Phone:561-628-6405
Practice Address - Fax:270-596-4457
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 4206133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered