Provider Demographics
NPI:1114004280
Name:LUCENA, FREDESWINDA (RD,MHSN)
Entity type:Individual
Prefix:MS
First Name:FREDESWINDA
Middle Name:
Last Name:LUCENA
Suffix:
Gender:F
Credentials:RD,MHSN
Other - Prefix:MS
Other - First Name:FREDESWINDA
Other - Middle Name:
Other - Last Name:LUCENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD,MHSN
Mailing Address - Street 1:240 RIVER PARK LN
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-2263
Mailing Address - Country:US
Mailing Address - Phone:760-960-1309
Mailing Address - Fax:
Practice Address - Street 1:240 RIVER PARK LN
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-2263
Practice Address - Country:US
Practice Address - Phone:760-960-1309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR980133NN1002X
CA1004378133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education