Provider Demographics
NPI:1457730103
Name:FLOCK, LORRAINE C (RDN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:C
Last Name:FLOCK
Suffix:
Gender:F
Credentials:RDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 BUCHANAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4029
Mailing Address - Country:US
Mailing Address - Phone:954-547-7771
Mailing Address - Fax:
Practice Address - Street 1:1715 BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4029
Practice Address - Country:US
Practice Address - Phone:954-547-7771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND2694133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered