Provider Demographics
NPI:1982636825
Name:CARRIZALES, LORENA (RD,LD)
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:CARRIZALES
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 86 STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141
Mailing Address - Country:US
Mailing Address - Phone:956-639-6373
Mailing Address - Fax:
Practice Address - Street 1:775 86 STREET
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141
Practice Address - Country:US
Practice Address - Phone:956-639-6373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX932080133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX932080OtherCDR
TXDT07186OtherLICENSED DIETITIAN