Provider Demographics
NPI:1295336881
Name:BOTA, LUMINITA ALINA (RDN)
Entity type:Individual
Prefix:MRS
First Name:LUMINITA
Middle Name:ALINA
Last Name:BOTA
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:20070 E DESCHUTES AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99016-5120
Mailing Address - Country:US
Mailing Address - Phone:206-422-3056
Mailing Address - Fax:
Practice Address - Street 1:4560 CRAIN HWY STE 101
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3084
Practice Address - Country:US
Practice Address - Phone:240-210-9725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1102234133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADI60957712OtherWASHINGTON STATE DEPARTMENT OF HEALTH
TXDT84373OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION
1102234OtherCOMMISSION ON DIETETIC REGISTRATION