Provider Demographics
NPI:1255092284
Name:LOPEZ, LEZLIE ANNETTE (RDN, LDN)
Entity type:Individual
Prefix:
First Name:LEZLIE
Middle Name:ANNETTE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 31220
Mailing Address - Street 2:
Mailing Address - City:FLORIDA
Mailing Address - State:PR
Mailing Address - Zip Code:00650-9515
Mailing Address - Country:US
Mailing Address - Phone:939-585-4321
Mailing Address - Fax:
Practice Address - Street 1:CARR. 665 KM. 1.4 BARRIO TOSAS
Practice Address - Street 2:
Practice Address - City:FLORIDA, PR
Practice Address - State:PR
Practice Address - Zip Code:00650-9515
Practice Address - Country:US
Practice Address - Phone:939-585-4321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2193133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered