Healthcare Provider Details

I. General information

NPI: 1164565446
Provider Name (Legal Business Name): LUCILLE BESELER LD RD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20483 VIA MARISA
BOCA RATON FL
33498-6708
US

IV. Provider business mailing address

20483 VIA MARISA
BOCA RATON FL
33498-6708
US

V. Phone/Fax

Practice location:
  • Phone: 954-360-7883
  • Fax: 954-360-7884
Mailing address:
  • Phone: 954-360-7883
  • Fax: 954-360-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberN2042
License Number StateFL

VIII. Authorized Official

Name: LUCILLE BESELER
Title or Position: OWNER
Credential:
Phone: 954-360-7883