Provider Demographics
NPI:1598232506
Name:LE MIRE, NARIA (RDN)
Entity Type:Individual
Prefix:
First Name:NARIA
Middle Name:
Last Name:LE MIRE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:MRS
Other - First Name:NARIA
Other - Middle Name:
Other - Last Name:LE MIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NARIA CUNEO
Mailing Address - Street 1:288 BROADWAY SPC 141A
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2318
Mailing Address - Country:US
Mailing Address - Phone:619-245-9336
Mailing Address - Fax:
Practice Address - Street 1:288 BROADWAY #141A
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910
Practice Address - Country:US
Practice Address - Phone:619-245-9336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-28
Last Update Date:2018-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86063186133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered