Provider Demographics
NPI:1013273028
Name:LISA S. EICHENBAUM, MS,RS,LD/N,P.A.
Entity Type:Organization
Organization Name:LISA S. EICHENBAUM, MS,RS,LD/N,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:S
Authorized Official - Last Name:EICHENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RD,LD/N
Authorized Official - Phone:305-445-4959
Mailing Address - Street 1:58 MIRACLE MILE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5404
Mailing Address - Country:US
Mailing Address - Phone:305-445-4959
Mailing Address - Fax:305-443-6116
Practice Address - Street 1:58 MIRACLE MILE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5404
Practice Address - Country:US
Practice Address - Phone:305-445-4959
Practice Address - Fax:305-443-6116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 1266133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN0004AMedicare PIN