Provider Demographics
NPI:1437728029
Name:LOPEZ, JAMIE (RDN)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:LOPEZ
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 1:93 BOORAEM AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-2401
Mailing Address - Country:US
Mailing Address - Phone:561-676-7981
Mailing Address - Fax:
Practice Address - Street 1:93 BOORAEM AVE APT 1
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-2401
Practice Address - Country:US
Practice Address - Phone:561-676-7981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND10299133V00000X
NY00987901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered