Provider Demographics
NPI:1437255593
Name:BERTHAUT, LISA GARZOTTO (RD, LDN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:GARZOTTO
Last Name:BERTHAUT
Suffix:
Gender:F
Credentials:RD, LDN, CDE
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:GARZOTTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:1620 BELLE CHASE HIGHWAY
Mailing Address - Street 2:SUITE #101
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7033
Mailing Address - Country:US
Mailing Address - Phone:504-265-8304
Mailing Address - Fax:504-309-4193
Practice Address - Street 1:1620 BELLE CHASE HIGHWAY
Practice Address - Street 2:SUITE #101
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7033
Practice Address - Country:US
Practice Address - Phone:504-265-8304
Practice Address - Fax:504-309-4193
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1445133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered