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NPI Code Detail

MEDICARE: ANA GABRIELA DEMENEGHI LUDKE RD, LDN

MEDICARE: ANA GABRIELA DEMENEGHI LUDKE RD, LDN
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
1133NN1002XNutrition Education NutritionistND10592FL
2133V00000XRegistered DietitianND10592FL

General Provider Information

NPI Number : 1104579879
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANA GABRIELA DEMENEGHI LUDKE RD, LDN
Provider Business Mailing Address
First Line : 5960 S JOG RD
Second Line :
City : LAKE WORTH
State : FL
Zip : 33467-6509
Country : US
Telephone Number : 561-253-6041
Fax Number :
Provider Business Practice Location Address
First Line : 5960 S JOG RD
Second Line :
City : LAKE WORTH
State : FL
Zip : 33467-6509
Country : US
Telephone Number : 561-253-6041
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2022
Last Update Date : 08/17/2022

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