Provider Demographics
NPI:1699518332
Name:RADO, LISA M (CN, IHC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:RADO
Suffix:
Gender:F
Credentials:CN, IHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 SUNNYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2246
Mailing Address - Country:US
Mailing Address - Phone:310-920-9236
Mailing Address - Fax:
Practice Address - Street 1:150 40TH ST
Practice Address - Street 2:
Practice Address - City:AVALON
Practice Address - State:NJ
Practice Address - Zip Code:08202-1465
Practice Address - Country:US
Practice Address - Phone:310-920-9236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty