Individual
MS. LISA BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RHN
Contact information
Practice address
13953 PANAY WAY APT 102, MARINA DEL REY, CA 90292-6189
(424) 844-5946
Mailing address
13953 PANAY WAY APT 102, MARINA DEL REY, CA 90292-6189
(424) 844-5946
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
RN326009
CA
Other
Enumeration date
02/12/2025
Last updated
02/12/2025
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