Provider Demographics
NPI:1831635853
Name:PUCCI, LEANDRO (NUTRITIONIST)
Entity Type:Individual
Prefix:
First Name:LEANDRO
Middle Name:
Last Name:PUCCI
Suffix:
Gender:M
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 N LAUREL AVE
Mailing Address - Street 2:APT 4
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6030
Mailing Address - Country:US
Mailing Address - Phone:323-719-2983
Mailing Address - Fax:
Practice Address - Street 1:1036 N LAUREL AVE
Practice Address - Street 2:APT 4
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-6030
Practice Address - Country:US
Practice Address - Phone:323-719-2983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-14
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic