Provider Demographics
NPI:1669939385
Name:HERZIG, LISA (RD, CDE)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HERZIG
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9898 N MILLBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1313
Mailing Address - Country:US
Mailing Address - Phone:559-940-2772
Mailing Address - Fax:
Practice Address - Street 1:9898 N MILLBROOK AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-1313
Practice Address - Country:US
Practice Address - Phone:559-940-2772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered