Healthcare Provider Details

I. General information

NPI: 1992499057
Provider Name (Legal Business Name): LUCIANA MAREGA GODOI RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 SE 3RD AVE APT 202
DANIA FL
33004-5517
US

IV. Provider business mailing address

1341 SE 3RD AVE APT 202
DANIA FL
33004-5517
US

V. Phone/Fax

Practice location:
  • Phone: 754-281-7626
  • Fax:
Mailing address:
  • Phone: 754-281-7626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND7945
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: