Provider Demographics
NPI:1003505199
Name:CRUZ LE DUC, LAUREN ALESSANDRA (CDR RDN)
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:ALESSANDRA
Last Name:CRUZ LE DUC
Suffix:
Gender:F
Credentials:CDR RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 MOHAVE DR
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324
Mailing Address - Country:US
Mailing Address - Phone:787-248-0343
Mailing Address - Fax:
Practice Address - Street 1:1230 MOHAVE DR
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324
Practice Address - Country:US
Practice Address - Phone:787-248-0343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86053186133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered