Individual
LISA HUGHES ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
501 DEL PRADO BLVD S, CAPE CORAL, FL 33990-2618
(239) 424-3120
(239) 424-1423
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 424-3120
(239) 343-4042
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
ND4772
FL
133V00000X
Registered Dietitian
Primary
ND4772
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125531700
—
FL
Enumeration date
09/19/2017
Last updated
02/28/2025
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