Provider Demographics
NPI:1124891643
Name:LUCA, ALYSON (RD, LDN)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:LUCA
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 C ST APT 5
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-1916
Mailing Address - Country:US
Mailing Address - Phone:201-916-0853
Mailing Address - Fax:
Practice Address - Street 1:265 C ST APT 5
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-1916
Practice Address - Country:US
Practice Address - Phone:201-916-0853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALDN6661133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered