Active NPI
Itchaqueira Beatriz Fontanez Vendrell, RD/LDN
- Registered Dietitian
- Wellington, FL
National Provider Identifier
1629664685
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 9854
- Practice address
- 1675 Polo Lake Dr E Apt 104
Wellington, FL 33414-3112 - Phone
- (863) 258-7986
- NPI assigned
- Dec 14, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Nutritionist | 133N00000X | |||
| Nutrition Education Nutritionist | 133NN1002X | |||
| Contractor | 171W00000X | |||
| Registered Dietitian | 133V00000X | 9854 | FL | Primary |
Addresses
Primary practice location
1675 Polo Lake Dr E Apt 104
Wellington, FL 33414-3112
Mailing address
1675 Polo Lake Dr E Apt 104
Wellington, FL 33414-3112
Phone (863) 258-7986
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9854 | FL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607904000000",
"number": "1629664685",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1675 POLO LAKE DR E APT 104",
"city": "WELLINGTON",
"state": "FL",
"postal_code": "334143112",
"telephone_number": "863-258-7986"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1675 POLO LAKE DR E APT 104",
"city": "WELLINGTON",
"state": "FL",
"postal_code": "334143112",
"telephone_number": "863-258-7986"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONTANEZ VENDRELL",
"first_name": "ITCHAQUEIRA",
"middle_name": "BEATRIZ",
"credential": "RD/LDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-12-14",
"last_updated": "2020-12-14",
"certification_date": "2020-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": null,
"license": null,
"primary": false
},
{
"code": "133NN1002X",
"taxonomy_group": "",
"desc": "Nutritionist, Nutrition, Education",
"state": null,
"license": null,
"primary": false
},
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": null,
"license": null,
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "FL",
"license": "9854",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wellington, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.