Individual
LISA DO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
2025 MORSE AVE, SACRAMENTO, CA 95825-2115
(916) 973-5000
Mailing address
2025 MORSE AVE, SACRAMENTO, CA 95825-2115
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86303831
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y4988339
MEDICARE, MEDICAL, MEDICAID
CA
Enumeration date
08/10/2022
Last updated
08/10/2022
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