Individual
DIANE KOPELAKIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD LD
Contact information
Practice address
7825 NAUTIQUE CT, LAKE WORTH, FL 33467-7791
(561) 436-6617
Mailing address
7825 NAUTIQUE CT, LAKE WORTH, FL 33467-7791
(561) 436-6617
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
ND3420
FL
133NN1002X
Nutrition Education Nutritionist
ND3420
FL
133V00000X
Registered Dietitian
Primary
ND3420
FL
133VN1006X
Metabolic Nutrition Registered Dietitian
ND3420
FL
133VN1101X
Gerontological Nutrition Registered Dietitian
ND3420
FL
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
ND3420
FL
133VN1501X
Sports Dietetics Nutrition Registered Dietitian
ND3420
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21000164980
USED LLC DOC # BC HAVE NO OTHER #
—
Enumeration date
01/20/2023
Last updated
01/20/2023
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