| Doctor Name: | LISA DE FAZIO |
| NPI Number: | 1154597623 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | R.D. |
| License Number: | 859439 |
| Business Practice Address: | 415 Rolling Oaks Dr Suite 210 Thousand Oaks, CA - 913611029 |
| Business Phone Number: | 8052990301 |
| Business Fax Number: | |
| Mailing Address: | 415 Rolling Oaks Dr, Suite 210 THOUSAND OAKS |
| State: | CA |
| Postal Code: | 913611029 |
| Phone Number: | 8052990301 |
| Fax Number: | |
| NPI Enumeration Date: | 05/05/2008 |
| NPI Last Update Date: | 06/26/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | 859439 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |