Provider Demographics
NPI:1457418303
Name:LLOSSAS, JOSE R (RD,LD)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:R
Last Name:LLOSSAS
Suffix:
Gender:M
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:PO BOX 2155
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-2155
Mailing Address - Country:US
Mailing Address - Phone:863-599-1657
Mailing Address - Fax:
Practice Address - Street 1:115 S GLORIA ST
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-3505
Practice Address - Country:US
Practice Address - Phone:863-983-2282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 4194133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered