Provider Demographics
NPI:1699138834
Name:BAKER, IRIS (RD)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20890 HIGHLAND LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-1666
Mailing Address - Country:US
Mailing Address - Phone:305-308-0020
Mailing Address - Fax:305-675-6217
Practice Address - Street 1:20890 HIGHLAND LAKES BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-1666
Practice Address - Country:US
Practice Address - Phone:305-308-0020
Practice Address - Fax:305-675-6217
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4408133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered