Provider Demographics
NPI:1609123454
Name:VIVES-LAWAL, KIM M (MS RD CDN)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:M
Last Name:VIVES-LAWAL
Suffix:
Gender:F
Credentials:MS RD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CASALS PL
Mailing Address - Street 2:4G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-3002
Mailing Address - Country:US
Mailing Address - Phone:718-379-0436
Mailing Address - Fax:
Practice Address - Street 1:100 CASALS PL
Practice Address - Street 2:4G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-3002
Practice Address - Country:US
Practice Address - Phone:718-379-0436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-11
Last Update Date:2012-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00720405133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered