Healthcare Provider Details

I. General information

NPI: 1730374224
Provider Name (Legal Business Name): LISA CHRISTINE BRENT N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA CHRISTINE STANICH N.D.

II. Dates (important events)

Enumeration Date: 09/08/2007
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 REDWOOD HWY FRONTAGE RD SUITE 200
MILL VALLEY CA
94941-3034
US

IV. Provider business mailing address

655 REDWOOD HWY FRONTAGE RD SUITE 200
MILL VALLEY CA
94941-3034
US

V. Phone/Fax

Practice location:
  • Phone: 415-569-4470
  • Fax: 415-888-8593
Mailing address:
  • Phone: 415-569-4470
  • Fax: 415-888-8593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC8477
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number68
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code172P00000X
TaxonomyNaprapath
License NumberND68
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: