Provider Demographics
NPI:1871351569
Name:COLES, EVA LUCY (RD)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:LUCY
Last Name:COLES
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 1:119 E 2ND CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-5106
Mailing Address - Country:US
Mailing Address - Phone:954-895-6431
Mailing Address - Fax:
Practice Address - Street 1:119 E 2ND CT
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-5106
Practice Address - Country:US
Practice Address - Phone:954-895-6431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86329478133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered