Provider Demographics
NPI:1205983970
Name:DE LORETTA, GINA LOUISE (RD (REGISTERED DIETI)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:LOUISE
Last Name:DE LORETTA
Suffix:
Gender:
Credentials:RD (REGISTERED DIETI
Other - Prefix:MISS
Other - First Name:GINA
Other - Middle Name:LOUISE
Other - Last Name:DE LORETTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD (REGISTERED DIETI
Mailing Address - Street 1:12665 SW GINGERLINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST. LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987
Mailing Address - Country:US
Mailing Address - Phone:240-320-2672
Mailing Address - Fax:
Practice Address - Street 1:12665 SW GINGERLINE DRIVE
Practice Address - Street 2:
Practice Address - City:PORT ST. LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987
Practice Address - Country:US
Practice Address - Phone:240-320-2672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4634133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered