Provider Demographics
NPI:1306835707
Name:EICHENBAUM, LISA ELLEN (MS RD LDIN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ELLEN
Last Name:EICHENBAUM
Suffix:
Gender:F
Credentials:MS RD LDIN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ELLEN
Other - Last Name:SCHOMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:58 MIRACLE MILE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5404
Mailing Address - Country:US
Mailing Address - Phone:305-445-4959
Mailing Address - Fax:305-443-6116
Practice Address - Street 1:58 MIRACLE MILE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5404
Practice Address - Country:US
Practice Address - Phone:305-445-4959
Practice Address - Fax:305-443-6116
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND1266133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered