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NPI Code Detail

MEDICARE: DR. LISA A BROCKMAN DO

MEDICARE: DR. LISA A BROCKMAN DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician20A8065CA
2208M00000XHospitalist Physician20A806CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1002A80650OTHERCAMEDI CAL #

General Provider Information

NPI Number : 1063417798
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA A BROCKMAN DO
Provider Business Mailing Address
First Line : 3820 MARTIN LUTHER KING JR BLVD
Second Line :
City : LYNWOOD
State : CA
Zip : 90262-3625
Country : US
Telephone Number : 310-632-0415
Fax Number : 310-639-2734
Provider Business Practice Location Address
First Line : 3820 MARTIN LUTHER KING JR BLVD
Second Line :
City : LYNWOOD
State : CA
Zip : 90262-3625
Country : US
Telephone Number : 310-632-0415
Fax Number : 310-639-2734
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2005
Last Update Date : 09/17/2012

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Directions to “ DR. LISA A BROCKMAN DO” Practice Location

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