Provider Demographics
NPI:1750059341
Name:LOUREKAS, SIMONA MARTINE (MS, RD, LDN, CHES)
Entity Type:Individual
Prefix:
First Name:SIMONA
Middle Name:MARTINE
Last Name:LOUREKAS
Suffix:
Gender:F
Credentials:MS, RD, LDN, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-726-8705
Mailing Address - Fax:617-724-7011
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-8705
Practice Address - Fax:617-724-7011
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4914-NU-NU133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered