Provider Demographics
NPI:1487283784
Name:LUONG, LUCILLE ROSE (RDN)
Entity type:Individual
Prefix:MRS
First Name:LUCILLE
Middle Name:ROSE
Last Name:LUONG
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:LUCILLE
Other - Middle Name:ROSE
Other - Last Name:RICHIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:8008 4A STREET NE
Mailing Address - Street 2:
Mailing Address - City:CALGARY
Mailing Address - State:ALBERTA
Mailing Address - Zip Code:T2K 5W8
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25301 PICO VISTA WAY
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-5222
Practice Address - Country:US
Practice Address - Phone:815-994-6795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86038485OtherCOMMISSION ON DIETETIC REGISTRATION