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NPI Code Detail

MEDICARE: DR. LISA MORAN PH.D.

MEDICARE: DR. LISA MORAN PH.D.
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
1103G00000XClinical NeuropsychologistPSY-2024-0071NM
2103G00000XClinical Neuropsychologist26724CA

General Provider Information

NPI Number : 1386030963
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA MORAN PH.D.
Provider Business Mailing Address
First Line : 6300 RIVERSIDE PLAZA LN NW STE 100
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87120-1908
Country : US
Telephone Number : 505-221-6214
Fax Number :
Provider Business Practice Location Address
First Line : 6300 RIVERSIDE PLAZA LN NW STE 100
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87120-1908
Country : US
Telephone Number : 505-221-6214
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2015
Last Update Date : 11/24/2025

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Directions to “ DR. LISA MORAN PH.D.” Practice Location

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