Healthcare Provider Details

I. General information

NPI: 1184826059
Provider Name (Legal Business Name): MS. LISA ANN CABRAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 WATERMAN AVE
EAST PROVIDENCE RI
02914-3525
US

IV. Provider business mailing address

344 STATE AVE
FALL RIVER MA
02724-1620
US

V. Phone/Fax

Practice location:
  • Phone: 401-435-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberLDN00568
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: