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Individual

ITCHAQUEIRA BEATRIZ FONTANEZ VENDRELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RD/LDN

Contact information

Practice address
1675 POLO LAKE DR E APT 104, WELLINGTON, FL 33414-3112
(863) 258-7986
Mailing address
1675 POLO LAKE DR E APT 104, WELLINGTON, FL 33414-3112
(863) 258-7986

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
133N00000X
Nutritionist
133NN1002X
Nutrition Education Nutritionist
133V00000X
Registered Dietitian
Primary
9854
FL
171W00000X
Contractor

Other

Enumeration date
12/14/2020
Last updated
12/14/2020
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