Provider Demographics
NPI:1013133693
Name:LORD, LILIA V (RD)
Entity Type:Individual
Prefix:
First Name:LILIA
Middle Name:V
Last Name:LORD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1043
Mailing Address - Street 2:ROSAMOND BLVD
Mailing Address - City:ROSAMOND
Mailing Address - State:CA
Mailing Address - Zip Code:93560-1043
Mailing Address - Country:US
Mailing Address - Phone:818-375-3484
Mailing Address - Fax:818-375-3644
Practice Address - Street 1:13652 CANTARA ST
Practice Address - Street 2:PANORAMA CITY
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-5423
Practice Address - Country:US
Practice Address - Phone:818-375-3484
Practice Address - Fax:818-375-3644
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAR361502133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered