Basic Information
| Provider Information | |||||||||
| NPI: | 1346426699 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAPO | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | |||||||||
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| Credential: | ND | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1450 NW 10TH AVE | ||||||||
| Address2: | BOX 016960 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331361011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052436061 | ||||||||
| FaxNumber: | 3052438470 | ||||||||
| Practice Location | |||||||||
| Address1: | 1450 NW 10TH AVE | ||||||||
| Address2: | BOX 016960 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331361011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052436061 | ||||||||
| FaxNumber: | 3052438470 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2008 | ||||||||
| LastUpdateDate: | 01/17/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | ND4971 | FL | Y | Dietary & Nutritional Service Providers | Nutritionist |
No ID Information.