Provider Demographics
NPI:1730374224
Name:BRENT, LISA CHRISTINE (ND)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:CHRISTINE
Last Name:BRENT
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:CHRISTINE
Other - Last Name:STANICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:655 REDWOOD HWY FRONTAGE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-3034
Mailing Address - Country:US
Mailing Address - Phone:415-569-4470
Mailing Address - Fax:415-888-8593
Practice Address - Street 1:655 REDWOOD HWY FRONTAGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3034
Practice Address - Country:US
Practice Address - Phone:415-569-4470
Practice Address - Fax:415-888-8593
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-08
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND68172P00000X
CAAC8477171100000X
CA68175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No172P00000XOther Service ProvidersNaprapath
No171100000XOther Service ProvidersAcupuncturist