Healthcare Provider Details

I. General information

NPI: 1619862091
Provider Name (Legal Business Name): LIZA MARIE SAN JUAN PILASPILAS DTR, CLC, CD(DONA)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 DOVE AVE
MARRERO LA
70072-5815
US

IV. Provider business mailing address

2929 DOVE AVE
MARRERO LA
70072-5815
US

V. Phone/Fax

Practice location:
  • Phone: 504-559-6011
  • Fax:
Mailing address:
  • Phone: 504-559-6011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number952028
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number230597
License Number StateLA
# 5
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number14964
License Number StateLA
# 6
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: