Provider Demographics
NPI:1427558444
Name:BALESTRINO, LISA (MS, RD, LDN, CSSD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BALESTRINO
Suffix:
Gender:F
Credentials:MS, RD, LDN, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 BAUM BLVD # 306
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3793
Mailing Address - Country:US
Mailing Address - Phone:412-593-2048
Mailing Address - Fax:
Practice Address - Street 1:5750 BAUM BLVD # 306
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3793
Practice Address - Country:US
Practice Address - Phone:412-593-2048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005075133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP78575Medicaid