Provider Demographics
NPI:1194134650
Name:LICHTERMAN, LORI (RD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:LICHTERMAN
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:BLUMIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:19849 HAYNES ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-2819
Mailing Address - Country:US
Mailing Address - Phone:954-536-5062
Mailing Address - Fax:
Practice Address - Street 1:10727 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4932
Practice Address - Country:US
Practice Address - Phone:954-536-5062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-09
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA991086133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered