Individual
MISS LUZVIMINDA MEGABUNG CABOTAJE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D, RD
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
812178
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
067448
MEDICARE PROVIDER ID NO.
NJ
Enumeration date
01/17/2008
Last updated
01/17/2008
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