Provider Demographics
NPI:1770889735
Name:LALUSH, SAMANTHA RIDER (RD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RIDER
Last Name:LALUSH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1591 ROYAL WAY
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-6331
Mailing Address - Country:US
Mailing Address - Phone:805-215-6572
Mailing Address - Fax:
Practice Address - Street 1:1022 MILL ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2784
Practice Address - Country:US
Practice Address - Phone:805-242-6417
Practice Address - Fax:805-540-5898
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00993722133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered