Provider Demographics
NPI:1326443839
Name:LOPEZ, DIANNA KATHRYN (RDN, LD/N)
Entity Type:Individual
Prefix:MRS
First Name:DIANNA
Middle Name:KATHRYN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RDN, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10203 PINK PALMATA CT
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-3627
Mailing Address - Country:US
Mailing Address - Phone:813-546-1143
Mailing Address - Fax:
Practice Address - Street 1:851 W LUMSDEN RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6280
Practice Address - Country:US
Practice Address - Phone:813-546-1143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4125133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered