Organization
MY FUNCTIONAL DIETITIAN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SIMA KAGANAS RD (OWNER)
(305) 213-2009
Entity
Organization
Contact information
Practice address
1045 NE 179TH TER, NORTH MIAMI BEACH, FL 33162-1256
(916) 633-1626
Mailing address
1045 NE 179TH TER, NORTH MIAMI BEACH, FL 33162-1256
(916) 633-1626
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
05/11/2022
Last updated
05/11/2022
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