Provider Demographics
NPI:1578845509
Name:GRIFFITH, LISA D (RD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:D
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6709 WOODS ISLAND CIR
Mailing Address - Street 2:APT 203
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-1483
Mailing Address - Country:US
Mailing Address - Phone:909-213-3945
Mailing Address - Fax:
Practice Address - Street 1:6709 WOODS ISLAND CIR
Practice Address - Street 2:APT 203
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-1483
Practice Address - Country:US
Practice Address - Phone:909-213-3945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA969989133V00000X
FL969989133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered