Provider Demographics
NPI:1194134650
Name:BLUMIN, LORI
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:BLUMIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:LICHTERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:11744 MOORPARK ST
Mailing Address - Street 2:UNIT R
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2166
Mailing Address - Country:US
Mailing Address - Phone:954-536-5062
Mailing Address - Fax:
Practice Address - Street 1:11744 MOORPARK ST
Practice Address - Street 2:UNIT R
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2166
Practice Address - Country:US
Practice Address - Phone:954-536-5062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-09
Last Update Date:2014-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA991086133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered