Individual
LISA DE FAZIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.
Contact information
Practice address
415 ROLLING OAKS DR, SUITE 210, THOUSAND OAKS, CA 91361-1029
(805) 299-0301
Mailing address
415 ROLLING OAKS DR STE 210, THOUSAND OAKS, CA 91361-1044
(805) 299-0301
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
859439
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
859439
DIETETIC REGISTRATION
CA
Enumeration date
05/05/2008
Last updated
11/18/2025
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