Healthcare Provider Details

I. General information

NPI: 1760782817
Provider Name (Legal Business Name): LISA MICHELLE BEAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2010
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 W COLE BLVD
CALEXICO CA
92231-9722
US

IV. Provider business mailing address

5654 LEESWAY BLVD
PENSACOLA FL
32504-7726
US

V. Phone/Fax

Practice location:
  • Phone: 760-357-2020
  • Fax: 760-357-1056
Mailing address:
  • Phone: 540-325-2458
  • Fax: 850-416-2467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME108952
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberTRN14227
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberA125372
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: