Provider Demographics
NPI:1386427227
Name:PALAU, JOEL ALEXANDER
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:ALEXANDER
Last Name:PALAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5837 SW 118TH AVE
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330-4179
Mailing Address - Country:US
Mailing Address - Phone:786-488-4024
Mailing Address - Fax:
Practice Address - Street 1:5837 SW 118TH AVE
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33330-4179
Practice Address - Country:US
Practice Address - Phone:786-488-4024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7002133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered