Healthcare Provider Details

I. General information

NPI: 1841246931
Provider Name (Legal Business Name): LISA MARIA COLLINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 CLINTON AVE
ALAMEDA CA
94501-4399
US

IV. Provider business mailing address

4100 REDWOOD RD #328
OAKLAND CA
94619-2363
US

V. Phone/Fax

Practice location:
  • Phone: 510-522-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA67814
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: