Healthcare Provider Details

I. General information

NPI: 1952206237
Provider Name (Legal Business Name): LISA M. TAYLOR RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA M PARDUE RD

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 75
NEWCASTLE CA
95658-0075
US

IV. Provider business mailing address

PO BOX 75
NEWCASTLE CA
95658-0075
US

V. Phone/Fax

Practice location:
  • Phone: 916-765-0659
  • Fax:
Mailing address:
  • Phone: 916-765-0659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: