Provider Demographics
NPI:1619258282
Name:LIPPMAN, ALISSA (MS, RD, CLE)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:LIPPMAN
Suffix:
Gender:F
Credentials:MS, RD, CLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 PIER AVE APT 108
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-5540
Mailing Address - Country:US
Mailing Address - Phone:310-902-7025
Mailing Address - Fax:
Practice Address - Street 1:418 PIER AVE APT 108
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5540
Practice Address - Country:US
Practice Address - Phone:310-902-7025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA979221133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered