Provider Demographics
NPI:1578749834
Name:CABOTAJE, LUZVIMINDA MEGABUNG (PHD, RD)
Entity Type:Individual
Prefix:MISS
First Name:LUZVIMINDA
Middle Name:MEGABUNG
Last Name:CABOTAJE
Suffix:
Gender:F
Credentials:PHD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 KLOCKNER RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690
Mailing Address - Country:US
Mailing Address - Phone:609-586-6321
Mailing Address - Fax:609-586-7634
Practice Address - Street 1:2065 KLOCKNER RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3414
Practice Address - Country:US
Practice Address - Phone:609-586-6321
Practice Address - Fax:609-586-7634
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL812178133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ067448OtherMEDICARE PROVIDER ID NO.
NJ067448OtherMEDICARE PROVIDER NO.