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NPI Code Detail

MEDICARE: MS. LISA ROBERTS RD

MEDICARE: MS. LISA ROBERTS RD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian969335CA

General Provider Information

NPI Number : 1780861542
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LISA ROBERTS RD
Provider Business Mailing Address
First Line : 29970 TECHNOLOGY DR STE 105
Second Line :
City : MURRIETA
State : CA
Zip : 92563-2646
Country : US
Telephone Number : 951-346-0064
Fax Number :
Provider Business Practice Location Address
First Line : 11801 PIERCE ST
Second Line :
City : RIVERSIDE
State : CA
Zip : 92505-4400
Country : US
Telephone Number : 951-704-5993
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2008
Last Update Date : 12/09/2020

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