Provider Demographics
NPI:1134490691
Name:ORENGO, LIZA (MPH, RD, CSR)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:
Last Name:ORENGO
Suffix:
Gender:F
Credentials:MPH, RD, CSR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 45782
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53744-5782
Mailing Address - Country:US
Mailing Address - Phone:608-284-8642
Mailing Address - Fax:833-679-0805
Practice Address - Street 1:1330 WALDORF BLVD APT 202
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-4495
Practice Address - Country:US
Practice Address - Phone:704-608-6613
Practice Address - Fax:833-679-0805
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-14
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60127442133V00000X
WI3359-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered