Provider Demographics
NPI:1417380478
Name:PIPER, LACEY (RD)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:PIPER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-4103
Mailing Address - Country:US
Mailing Address - Phone:831-419-5980
Mailing Address - Fax:
Practice Address - Street 1:2841 HARBOR BLVD.
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001
Practice Address - Country:US
Practice Address - Phone:831-419-5980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86019315133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered