Provider Demographics
NPI:1134994460
Name:LU, STEPHANIE (RDN)
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:
Last Name:LU
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 IDAHO ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-1272
Mailing Address - Country:US
Mailing Address - Phone:805-267-6666
Mailing Address - Fax:
Practice Address - Street 1:4330 IDAHO ST APT 3
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-1272
Practice Address - Country:US
Practice Address - Phone:805-267-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86344774133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered