Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CH6743 | FL |
NPI | 1033261482 |
---|---|
Provider Name | Dr. Aliya Redwood |
First Address | Wesley Chapel, FL 33544-4036 |
Second Address | Wesley Chapel, FL 33544-4036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U50948 | (02) | FL |