Healthcare Provider Details

I. General information

NPI: 1699895326
Provider Name (Legal Business Name): LISA E PULVER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 N. ROXBURY #1001
BEVERLY HILLS CA
90210
US

IV. Provider business mailing address

563 33RD ST
MANHATTAN BEACH CA
90266-3405
US

V. Phone/Fax

Practice location:
  • Phone: 310-796-1103
  • Fax: 310-545-1169
Mailing address:
  • Phone: 310-291-0263
  • Fax: 310-545-1169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA2010
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: