Individual
JESSICA BASTIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
400 NE 3RD AVE APT 1520, FORT LAUDERDALE, FL 33301-4099
(954) 651-4748
Mailing address
4748 NE 17TH AVE, OAKLAND PARK, FL 33334-5610
(954) 651-4748
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
ND12214
FL
Other
Enumeration date
08/09/2023
Last updated
08/09/2023
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