=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619862091
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LIZA MARIE SAN JUAN PILASPILAS DTR, CLC, CD(DONA)
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2025
-----------------------------------------------------
Last Update Date | 06/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2929 DOVE AVE
-----------------------------------------------------
City | MARRERO
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70072-5815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-559-6011
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2929 DOVE AVE
-----------------------------------------------------
City | MARRERO
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70072-5815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-559-6011
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 136A00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietetic Technician
-----------------------------------------------------
License Number | 952028
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 172V00000X
-----------------------------------------------------
Taxonomy Name | Community Health Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 374J00000X
-----------------------------------------------------
Taxonomy Name | Doula
-----------------------------------------------------
License Number | 14964
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 174N00000X
-----------------------------------------------------
Taxonomy Name | Lactation Consultant (Non-RN)
-----------------------------------------------------
License Number | 230597
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------