Individual
MS. LISA ANN LICAVOLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
2289 REDLANDS DR, NEWPORT BEACH, CA 92660
(949) 646-4842
(949) 646-4978
Mailing address
2289 REDLANDS DR, NEWPORT BEACH, CA 92660
(949) 646-4842
(949) 646-4978
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
—
CA
133V00000X
Registered Dietitian
Primary
R-553289
CA
Other
Enumeration date
03/15/2018
Last updated
03/15/2018
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