Provider Demographics
NPI:1104674316
Name:PENAFUERTE, MA. LILIBETH K (MS, RD)
Entity type:Individual
Prefix:MRS
First Name:MA. LILIBETH
Middle Name:K
Last Name:PENAFUERTE
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:MISS
Other - First Name:MA LILIBETH
Other - Middle Name:G
Other - Last Name:KATIGBAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2612 BROOKDALE LN
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-1310
Mailing Address - Country:US
Mailing Address - Phone:909-267-8974
Mailing Address - Fax:
Practice Address - Street 1:1011 BALDWIN PARK BLVD
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-5806
Practice Address - Country:US
Practice Address - Phone:833-574-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-11
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86001701133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered