Provider Demographics
NPI:1407595523
Name:LAGANIERE, CHRISTY BRISSETTE (RD)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:BRISSETTE
Last Name:LAGANIERE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:ELIZABETH
Other - Last Name:BRISSETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:100 BAYVIEW CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2963
Mailing Address - Country:US
Mailing Address - Phone:949-239-2225
Mailing Address - Fax:
Practice Address - Street 1:27522 JAQUITA PL
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-6046
Practice Address - Country:US
Practice Address - Phone:312-859-1649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1067559133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered