Provider Demographics
NPI:1902255961
Name:CONTRERAS, LISA MARIE (RD, LD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:CONTRERAS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 W CHARLESTON BLVD STE 290
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2353
Mailing Address - Country:US
Mailing Address - Phone:702-671-5136
Mailing Address - Fax:702-671-5198
Practice Address - Street 1:1707 W CHARLESTON BLVD STE 290
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2353
Practice Address - Country:US
Practice Address - Phone:702-671-6469
Practice Address - Fax:702-671-5198
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV39056-DI-0133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered