Provider Demographics
NPI:1720212913
Name:TAMI, LISA MARTINE (RD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARTINE
Last Name:TAMI
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 1:2825 J ST
Mailing Address - Street 2:SUITE 435A
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4300
Mailing Address - Country:US
Mailing Address - Phone:916-978-0300
Mailing Address - Fax:916-978-0333
Practice Address - Street 1:2825 J ST
Practice Address - Street 2:SUITE 435
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4300
Practice Address - Country:US
Practice Address - Phone:916-978-0300
Practice Address - Fax:916-978-0333
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA831658133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered