Provider Demographics
NPI:1568713089
Name:GARCIA, LISA (RD, LD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 PALOMINO LN
Mailing Address - Street 2:SUITE 703
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6448
Mailing Address - Country:US
Mailing Address - Phone:603-315-7936
Mailing Address - Fax:
Practice Address - Street 1:82 PALOMINO LN
Practice Address - Street 2:SUITE 703
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6448
Practice Address - Country:US
Practice Address - Phone:603-315-7936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0651133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered