Provider Demographics
NPI:1013252840
Name:PIEDISCALZI, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PIEDISCALZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 PACHECO AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1233
Mailing Address - Country:US
Mailing Address - Phone:831-334-7250
Mailing Address - Fax:
Practice Address - Street 1:334 PACHECO AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-1233
Practice Address - Country:US
Practice Address - Phone:831-334-7250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4981171100000X
CA11019787174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No171100000XOther Service ProvidersAcupuncturist