Licavoli, Lisa Ann

Licavoli, Lisa Ann is an sole proprietor health care provider with primary practice located at 2289 Redlands Dr , Newport Beach CA 92660. She recently has 2 registered licenses in different health care specialties including Dietary & Nutritional Service Providers / Nutritionist, Dietary & Nutritional Service Providers / Dietitian, Registered. Dietary & Nutritional Service Providers / Dietitian, Registered is her primary health care specialty. Licavoli, Lisa Ann can be contacted via phone (949) 646-4842.

Contact Information

Primary practice address
2289 Redlands Dr Newport Beach CA 92660
Phone: (949) 646-4842
Fax: (949) 646-4978
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dietary & Nutritional Service Providers / Nutritionist 133N00000X California
Dietary & Nutritional Service Providers / Dietitian, Registered 133V00000X R-553289 California

Profile Details

NPI number 1063915080
LBN Legal business name Licavoli, Lisa Ann
Credentials Registered Dietitian (RD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 15th, 2018
Last updated Mar 15th, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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