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1063915080
LISA ANN LICAVOLI
NEWPORT BEACH, CA
NPI
1063915080
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
133V00000X Dietitian, Registered
(Licence: CA R-553289)
Additional Taxonomies
133N00000X Nutritionist
Enumeration Date
2018-03-15
Last Update Date
2018-03-15
Business Address
Ms. LISA ANN LICAVOLI R.D.
2289 REDLANDS DR
NEWPORT BEACH, CA 92660
Phone number: 949-646-4842
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Mailing Address
Ms. LISA ANN LICAVOLI R.D.
2289 REDLANDS DR
NEWPORT BEACH, CA 92660
Phone number: 949-646-4842
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