Provider Demographics
NPI:1033440235
Name:HUBBARD, LISA A (RD,LD)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7237 JANET ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-6930
Mailing Address - Country:US
Mailing Address - Phone:706-473-2855
Mailing Address - Fax:866-423-4939
Practice Address - Street 1:7237 JANET ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6930
Practice Address - Country:US
Practice Address - Phone:706-473-2855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86573133V00000X
GALD001250133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered