Provider Demographics
NPI:1053052209
Name:PIMENTEL, LAUREN (RD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:PIMENTEL
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 1:1304 MIDLAND AVE APT B30
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-1435
Mailing Address - Country:US
Mailing Address - Phone:914-426-9263
Mailing Address - Fax:
Practice Address - Street 1:1304 MIDLAND AVE APT B30
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-1435
Practice Address - Country:US
Practice Address - Phone:914-426-9263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-03
Last Update Date:2022-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT87469133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered