Provider Demographics
NPI:1366962086
Name:BRICENO, LUCIA EUGENIA (MS, RD, CNSC)
Entity type:Individual
Prefix:
First Name:LUCIA
Middle Name:EUGENIA
Last Name:BRICENO
Suffix:
Gender:F
Credentials:MS, RD, CNSC
Other - Prefix:
Other - First Name:LUCIA
Other - Middle Name:EUGENIA
Other - Last Name:BRICENO ALLIEGRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RD, CNSC
Mailing Address - Street 1:3528 SAWTELLE BLVD APT 7
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-2931
Mailing Address - Country:US
Mailing Address - Phone:310-890-1230
Mailing Address - Fax:
Practice Address - Street 1:4650 W SUNSET BLVD # 8
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-367-7842
Practice Address - Fax:323-361-1109
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86011308133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric