Provider Demographics
NPI:1225816283
Name:VALENCIA-PENAGOS, LUZ ELENA (RDN)
Entity Type:Individual
Prefix:MRS
First Name:LUZ
Middle Name:ELENA
Last Name:VALENCIA-PENAGOS
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 1:912 KINGS CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3053
Mailing Address - Country:US
Mailing Address - Phone:516-647-2035
Mailing Address - Fax:
Practice Address - Street 1:912 KINGS CT
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-3053
Practice Address - Country:US
Practice Address - Phone:516-647-2035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004962133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered