Provider Demographics
NPI:1477763159
Name:LARA, REYNA YOHANA (RD)
Entity Type:Individual
Prefix:
First Name:REYNA
Middle Name:YOHANA
Last Name:LARA
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 1:3614 SW 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7631
Mailing Address - Country:US
Mailing Address - Phone:786-269-5639
Mailing Address - Fax:
Practice Address - Street 1:150 S PINE ISLAND RD STE 372
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2667
Practice Address - Country:US
Practice Address - Phone:888-964-1975
Practice Address - Fax:877-743-5351
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4465133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered