Provider Demographics
NPI:1760650097
Name:BELLINI, LISA MARGARET (MS RD)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARGARET
Last Name:BELLINI
Suffix:
Gender:F
Credentials:MS RD
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:GERGLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS RD
Mailing Address - Street 1:91 BOXFORD PL
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-3313
Mailing Address - Country:US
Mailing Address - Phone:925-963-3663
Mailing Address - Fax:
Practice Address - Street 1:91 BOXFORD PL
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-3313
Practice Address - Country:US
Practice Address - Phone:925-963-3663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY609292133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA147626OtherMEDICARE PTAN