Provider Demographics
NPI:1013941863
Name:LOPEZ, DENNISE (MBA, RD, CSR)
Entity type:Individual
Prefix:
First Name:DENNISE
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MBA, RD, CSR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4477 BRENTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3856
Mailing Address - Country:US
Mailing Address - Phone:540-632-8325
Mailing Address - Fax:
Practice Address - Street 1:4477 BRENTWOOD CT
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3856
Practice Address - Country:US
Practice Address - Phone:540-632-8325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2024-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA927332133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered