Provider Demographics
NPI:1376006924
Name:CANUL, LUCIA (RD)
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:
Last Name:CANUL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:LUCIA
Other - Middle Name:
Other - Last Name:CANUL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:PO BOX 9413
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-9413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9413 BISON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92658-9413
Practice Address - Country:US
Practice Address - Phone:949-241-3544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
86096940133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered