Healthcare Provider Details

I. General information

NPI: 1013252840
Provider Name (Legal Business Name): LISA PIEDISCALZI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2012
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 PACHECO AVE
SANTA CRUZ CA
95062-1233
US

IV. Provider business mailing address

334 PACHECO AVE
SANTA CRUZ CA
95062-1233
US

V. Phone/Fax

Practice location:
  • Phone: 831-334-7250
  • Fax:
Mailing address:
  • Phone: 831-334-7250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number4981
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number11019787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: