Provider Demographics
NPI:1790174746
Name:PADUA-PEREZ, LUZ DAMARIS (RD, LDN)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:DAMARIS
Last Name:PADUA-PEREZ
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 NORMANDY SQUARE PL
Mailing Address - Street 2:APT #F
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-6133
Mailing Address - Country:US
Mailing Address - Phone:301-807-0779
Mailing Address - Fax:
Practice Address - Street 1:2407 NORMANDY SQUARE PL
Practice Address - Street 2:APT #F
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-6133
Practice Address - Country:US
Practice Address - Phone:301-807-0779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3716133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered