Healthcare Provider Details

I. General information

NPI: 1154352870
Provider Name (Legal Business Name): LISA J JOSEPHSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 WEST ORANGE AVENUE
ANAHEIM CA
92804
US

IV. Provider business mailing address

PO BOX 244
STANTON CA
90680
US

V. Phone/Fax

Practice location:
  • Phone: 714-827-3000
  • Fax:
Mailing address:
  • Phone: 562-809-3570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG72975
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: