Provider Demographics
NPI:1104637842
Name:AQUIJE, GABRIEL (MS, RDN, LDN, CDN)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:AQUIJE
Suffix:
Gender:M
Credentials:MS, RDN, LDN, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8134 THAMES BLVD APT A
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-8308
Mailing Address - Country:US
Mailing Address - Phone:917-775-2796
Mailing Address - Fax:
Practice Address - Street 1:310 E 44TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4422
Practice Address - Country:US
Practice Address - Phone:917-775-2796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL86303355133V00000X
NY012300-01133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered