Provider Demographics
NPI:1366144651
Name:BRYANT, LISA LEE (RDN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LEE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11342 WHITE OAK AVE
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-3311
Mailing Address - Country:US
Mailing Address - Phone:818-360-8679
Mailing Address - Fax:
Practice Address - Street 1:HENRY MAYO NEWHALL HOSP, 23845 MCBEAN PARKWAY
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2083
Practice Address - Country:US
Practice Address - Phone:661-200-1448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered