Healthcare Provider Details

I. General information

NPI: 1154810216
Provider Name (Legal Business Name): LORI B KUPFERMAN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 05/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 NE 2ND ST # 373
BOCA RATON FL
33432-3908
US

IV. Provider business mailing address

102 NE 2ND ST # 373
BOCA RATON FL
33432-3908
US

V. Phone/Fax

Practice location:
  • Phone: 954-654-0245
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND4987
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: