Provider Demographics
NPI:1396383246
Name:LUKES DIETITIANS
Entity Type:Organization
Organization Name:LUKES DIETITIANS
Other - Org Name:FOOD PHARMACY RD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-273-9444
Mailing Address - Street 1:5030 E 2ND ST STE 200A
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5349
Mailing Address - Country:US
Mailing Address - Phone:909-273-9444
Mailing Address - Fax:
Practice Address - Street 1:5030 E 2ND ST STE 200A
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5349
Practice Address - Country:US
Practice Address - Phone:909-273-9444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1659827806OtherDIETITIAN NPI