Provider Demographics
NPI:1619377462
Name:AL-RACHACH, LINA (RD, CDN)
Entity type:Individual
Prefix:MS
First Name:LINA
Middle Name:
Last Name:AL-RACHACH
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 E 40TH ST APT 10A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1747
Mailing Address - Country:US
Mailing Address - Phone:212-949-9809
Mailing Address - Fax:
Practice Address - Street 1:235 E 40TH ST APT 10A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1747
Practice Address - Country:US
Practice Address - Phone:212-949-9809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
R804851133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered