Healthcare Provider Details

I. General information

NPI: 1659197754
Provider Name (Legal Business Name): LISHA ZHOU RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2024
Last Update Date: 11/23/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 EDDY ST
SAN FRANCISCO CA
94109-7753
US

IV. Provider business mailing address

830 EDDY ST
SAN FRANCISCO CA
94109-7753
US

V. Phone/Fax

Practice location:
  • Phone: 347-429-1372
  • Fax:
Mailing address:
  • Phone: 347-429-1372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86392611
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: