Provider Demographics
NPI:1245889849
Name:RIVERA, LUANNA LUCAS (RD, LD)
Entity type:Individual
Prefix:
First Name:LUANNA
Middle Name:LUCAS
Last Name:RIVERA
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3391 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-1980
Mailing Address - Country:US
Mailing Address - Phone:954-294-6236
Mailing Address - Fax:
Practice Address - Street 1:3391 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-1980
Practice Address - Country:US
Practice Address - Phone:954-294-6236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8341133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered