Provider Demographics
NPI:1417733429
Name:LAVINE, LUCY (RD)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:LAVINE
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 1:12757 VENICE BLVD APT 8
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-3799
Mailing Address - Country:US
Mailing Address - Phone:908-721-7237
Mailing Address - Fax:
Practice Address - Street 1:12757 VENICE BLVD APT 8
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-3799
Practice Address - Country:US
Practice Address - Phone:908-721-7237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86081359133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered