MEDICARE: DR. LISA M ASTA MD

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
1	208000000X	Pediatrics Physician	G083245	CA

General Provider Information

NPI Number	:	1639173545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA M ASTA MD

Provider Business Mailing Address
First Line	:	1679 SAN LORENZO AVE
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94707-1823
Country	:	US
Telephone Number	:	925-939-7334
Fax Number	:

Provider Business Practice Location Address
First Line	:	2999 REGENT ST STE 325
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94705-2118
Country	:	US
Telephone Number	:	925-438-1100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	04/18/2022

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