Basic Information
Provider Information
NPI: 1003004730
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GATES
FirstName: HELEN
MiddleName: BERINGER
NamePrefix:  
NameSuffix:  
Credential: MAG,RD,LD/N
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: CINDRICH
OtherFirstName: HELEN
OtherMiddleName: MARIE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: MAG,RD,LD/N
OtherLastNameType: 1
Mailing Information
Address1: 1290 GOLFVIEW AVE FL 4
Address2:  
City: BARTOW
State: FL
PostalCode: 338306703
CountryCode: US
TelephoneNumber: 8635197900
FaxNumber: 8635197696
Practice Location
Address1: 1255 BRICE BLVD
Address2:  
City: BARTOW
State: FL
PostalCode: 338306735
CountryCode: US
TelephoneNumber: 8635198233
FaxNumber: 8635198304
Other Information
ProviderEnumerationDate: 10/09/2007
LastUpdateDate: 10/09/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
133V00000XND 930FLY Dietary & Nutritional Service ProvidersDietitian, Registered 

No ID Information.


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