Healthcare Provider Details

I. General information

NPI: 1811283682
Provider Name (Legal Business Name): LISA ANN PRIETO PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 34TH ST STE 100200
BAKERSFIELD CA
93301-2305
US

IV. Provider business mailing address

PO BOX 11702
BAKERSFIELD CA
93389-1702
US

V. Phone/Fax

Practice location:
  • Phone: 661-565-6279
  • Fax:
Mailing address:
  • Phone: 661-565-6279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: