Provider Demographics
NPI:1609379254
Name:FOX, CATHY A (RD)
Entity type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:A
Last Name:FOX
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 1:11011 HOFFNER EDGE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-4085
Mailing Address - Country:US
Mailing Address - Phone:240-675-0146
Mailing Address - Fax:
Practice Address - Street 1:11232 BOYETTE RD # 1039
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-8009
Practice Address - Country:US
Practice Address - Phone:240-675-0146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-09
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7493133V00000X
FL7493133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered