Provider Demographics
NPI:1881319879
Name:LEE, LINY NATALIA (MS, RD, CSG, CSR)
Entity type:Individual
Prefix:
First Name:LINY
Middle Name:NATALIA
Last Name:LEE
Suffix:
Gender:F
Credentials:MS, RD, CSG, CSR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 SUMMIT ST APT B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-3272
Mailing Address - Country:US
Mailing Address - Phone:415-244-8853
Mailing Address - Fax:
Practice Address - Street 1:107 SUMMIT ST APT B
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-3272
Practice Address - Country:US
Practice Address - Phone:415-244-8853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1073392133VN1005X, 133VN1101X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Multi-Specialty
No133VN1101XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Gerontological