MEDICARE: MRS. LUMINITA ALINA BOTA RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	1102234

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DI60957712	OTHER	WA	WASHINGTON STATE DEPARTMENT OF HEALTH
2	DT84373	OTHER	TX	TEXAS DEPARTMENT OF LICENSING AND REGULATION
3	1102234	OTHER		COMMISSION ON DIETETIC REGISTRATION

General Provider Information

NPI Number	:	1295336881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LUMINITA ALINA BOTA RDN

Provider Business Mailing Address
First Line	:	20070 E DESCHUTES AVE
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99016-5120
Country	:	US
Telephone Number	:	206-422-3056
Fax Number	:

Provider Business Practice Location Address
First Line	:	4560 CRAIN HWY STE 101
Second Line	:
City	:	WHITE PLAINS
State	:	MD
Zip	:	20695-3084
Country	:	US
Telephone Number	:	240-210-9725
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2020
Last Update Date	:	11/02/2020

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