Most Relevant Information
Provider Data
| NPI Number: | 1003591694 |
| Provider Name: | ALICIA KAROL BLONG RD |
| Entity Type: | Individual |
| Taxonomy Code: | 133V00000X |
| Specialty: | Dietitian, Registered |
| License Number: | ND12127 |
Most Important Dates
| Enumeration Date: | 06/20/2023 |
| Last Updated: | 06/28/2023 |
Provider Practice Location
4500 SAN PABLO RD S
JACKSONVILLE
FL
322241865
Practice Location Phone/Fax
| Phone: | 9049532000 |
| Fax: |
Provider Mailing Location
4500 SAN PABLO RD S
JACKSONVILLE
FL
322241865
Provider Mailing Phone/Fax
| Phone: | 9049532000 |
| Fax: |