Provider Demographics
NPI:1073377784
Name:RUMBOLZ, LISA DAWN (RDN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DAWN
Last Name:RUMBOLZ
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4243 MARY ELLEN AVE APT 17
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-1863
Mailing Address - Country:US
Mailing Address - Phone:818-399-4013
Mailing Address - Fax:
Practice Address - Street 1:4243 MARY ELLEN AVE APT 17
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-1863
Practice Address - Country:US
Practice Address - Phone:181-839-9401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA895007133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered