Provider Demographics
NPI:1689330334
Name:LATINA NUTRITIONISTA LLC
Entity Type:Organization
Organization Name:LATINA NUTRITIONISTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEDA
Authorized Official - Middle Name:P
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:RDN, LDN
Authorized Official - Phone:305-484-1377
Mailing Address - Street 1:14304 FREDRICKSBURG DR APT 403
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-8619
Mailing Address - Country:US
Mailing Address - Phone:305-484-1377
Mailing Address - Fax:
Practice Address - Street 1:14304 FREDRICKSBURG DR APT 403
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-8619
Practice Address - Country:US
Practice Address - Phone:305-484-1377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty