Provider Demographics
NPI:1477758381
Name:NOVAK BULL, LORENA (RD)
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:NOVAK BULL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:LORENA
Other - Middle Name:
Other - Last Name:NOVAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17130 VAN BUREN BLVD # 407
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-5905
Mailing Address - Country:US
Mailing Address - Phone:951-756-3953
Mailing Address - Fax:
Practice Address - Street 1:15681 WINTERS LN
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-9503
Practice Address - Country:US
Practice Address - Phone:951-858-4599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747A0650X
CA810043133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered