Provider Demographics
NPI:1659135366
Name:GOOCH, LORI B (RDN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:B
Last Name:GOOCH
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 WOOD RUN
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-6665
Mailing Address - Country:US
Mailing Address - Phone:719-339-9728
Mailing Address - Fax:
Practice Address - Street 1:165 WOOD RUN
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-6665
Practice Address - Country:US
Practice Address - Phone:719-339-9728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered