Provider Demographics
NPI:1194975615
Name:BERROCAL, MELISSA MARIA (RD, MS)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIA
Last Name:BERROCAL
Suffix:
Gender:F
Credentials:RD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 SW 26TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2303
Mailing Address - Country:US
Mailing Address - Phone:305-490-5070
Mailing Address - Fax:305-553-8563
Practice Address - Street 1:11001 SW 26TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2303
Practice Address - Country:US
Practice Address - Phone:305-490-5070
Practice Address - Fax:305-553-8563
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 5394133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education