Healthcare Provider Details

I. General information

NPI: 1023261351
Provider Name (Legal Business Name): LISA FLORO RIVARD RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N DATE ST
ESCONDIDO CA
92025-3413
US

IV. Provider business mailing address

425 N DATE ST
ESCONDIDO CA
92025-3413
US

V. Phone/Fax

Practice location:
  • Phone: 760-518-3978
  • Fax: 858-626-5630
Mailing address:
  • Phone: 760-518-3978
  • Fax: 858-626-5630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN369595
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN369595
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: