Provider Demographics
NPI:1396272860
Name:LAGUERTA, TARA SUE (RDN)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:SUE
Last Name:LAGUERTA
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:SUE
Other - Last Name:KENNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:5916 ALINGTON BEND DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-7463
Mailing Address - Country:US
Mailing Address - Phone:616-881-2213
Mailing Address - Fax:
Practice Address - Street 1:5916 ALINGTON BEND DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-7463
Practice Address - Country:US
Practice Address - Phone:616-881-2213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-16
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV39209-DI-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered