Provider Demographics
NPI:1336342633
Name:POON, POONHAR LOUISA (MS, RD)
Entity Type:Individual
Prefix:MISS
First Name:POONHAR
Middle Name:LOUISA
Last Name:POON
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 HARVARD AVE UNIT 24
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3573
Mailing Address - Country:US
Mailing Address - Phone:781-475-8687
Mailing Address - Fax:
Practice Address - Street 1:35 KNEELAND ST STE 5
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1523
Practice Address - Country:US
Practice Address - Phone:617-636-9941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2087133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal