Provider Demographics
NPI:1912727330
Name:PEREZ, BRIANA NICOLE (RD, LDN)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:NICOLE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12224 SW 109TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-4576
Mailing Address - Country:US
Mailing Address - Phone:305-343-4393
Mailing Address - Fax:
Practice Address - Street 1:12224 SW 109TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-4576
Practice Address - Country:US
Practice Address - Phone:305-343-4393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86331424133V00000X
FL12602133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered