Provider Demographics
NPI:1649991241
Name:LOVINGER, TARA RAE (MS, RD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:RAE
Last Name:LOVINGER
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 1:3077 S 31ST DR
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7494
Mailing Address - Country:US
Mailing Address - Phone:636-633-1132
Mailing Address - Fax:
Practice Address - Street 1:2400 SOUTH AVENUE A
Practice Address - Street 2:FOOD & NUTRITION SERVICES
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364
Practice Address - Country:US
Practice Address - Phone:928-336-7152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered