Provider Demographics
NPI:1558197947
Name:LUNA, DOMINICK (RDN, LDN)
Entity type:Individual
Prefix:
First Name:DOMINICK
Middle Name:
Last Name:LUNA
Suffix:
Gender:M
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2571 RED EGRET DR
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-2990
Mailing Address - Country:US
Mailing Address - Phone:908-267-1599
Mailing Address - Fax:
Practice Address - Street 1:2571 RED EGRET DR
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-2990
Practice Address - Country:US
Practice Address - Phone:908-267-1599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND11200133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered