Provider Demographics
NPI:1497266142
Name:SPICHKIN ROSENBLUM, LUBA (RDN)
Entity Type:Individual
Prefix:
First Name:LUBA
Middle Name:
Last Name:SPICHKIN ROSENBLUM
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:LUBA
Other - Middle Name:
Other - Last Name:ROSENBLUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDN
Mailing Address - Street 1:235 24TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90402-2515
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:235 24TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90402-2515
Practice Address - Country:US
Practice Address - Phone:310-486-3901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-21
Last Update Date:2017-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered