Provider Demographics
NPI:1467738484
Name:LIEBERSTEIN, ANDREA E (MPH, RD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:E
Last Name:LIEBERSTEIN
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 DE LONG AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945
Mailing Address - Country:US
Mailing Address - Phone:415-497-3674
Mailing Address - Fax:415-892-8962
Practice Address - Street 1:800 DE LONG AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945
Practice Address - Country:US
Practice Address - Phone:415-497-3674
Practice Address - Fax:415-892-8962
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA724399133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic