Provider Demographics
NPI:1518298074
Name:KOTLER, LISA KANDELL (MS, RD, CSP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:KANDELL
Last Name:KOTLER
Suffix:
Gender:F
Credentials:MS, RD, CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8108 E MICHELLE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5404
Mailing Address - Country:US
Mailing Address - Phone:480-251-1303
Mailing Address - Fax:480-393-3072
Practice Address - Street 1:9201 E MOUNTAIN VIEW RD
Practice Address - Street 2:STE 120
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258
Practice Address - Country:US
Practice Address - Phone:480-587-6980
Practice Address - Fax:480-882-5023
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered