Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CA16815 | CA |
NPI | 1376853903 |
---|---|
Provider Name | Dr. Lisa M Portera-Perry |
First Address | Walnut Creek, CA 94596-5230 |
Second Address | Walnut Creek, CA 94596-5230 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2010 |
Last Update Date | 17/10/2010 |