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General NPI Number Information
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NPI Number | 1982061008
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Entity Type | Individual
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Provider Name | LISA JEWETT RN, CDE
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Gender | Female
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Dates
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Enumeration Date | 01/20/2016
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Last Update Date | 03/18/2016
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Provider Practice Location Address
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Address Line | 1501 TROUSDALE DR 3RD FLOOR
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City | BURLINGAME
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State | CA
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Zip | 94010-4506
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Country | US
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Telephone | 650-652-8500
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Fax | 650-652-8556
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Provider Business Mailing Address
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Address Line | 577 AIRPORT BLVD STE 300
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City | BURLINGAME
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State | CA
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Zip | 94010-2048
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Country | US
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Telephone | 650-240-8198
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Fax | 408-328-5695
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number | PHN41722
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License Number State | CA
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