Provider Demographics
NPI:1144092693
Name:HENAO, DANNIA COLETTE (RDN)
Entity type:Individual
Prefix:
First Name:DANNIA
Middle Name:COLETTE
Last Name:HENAO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6729 SW 40TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-3203
Mailing Address - Country:US
Mailing Address - Phone:954-393-5333
Mailing Address - Fax:
Practice Address - Street 1:1223 1/2 BERKELEY ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1609
Practice Address - Country:US
Practice Address - Phone:954-393-5333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered