Healthcare Provider Details

I. General information

NPI: 1700380441
Provider Name (Legal Business Name): LISA CONSIDINE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 PROSPECT PL STE 350
CORONADO CA
92118-1995
US

IV. Provider business mailing address

4733 W SUNSET BLVD FL 3
LOS ANGELES CA
90027-6021
US

V. Phone/Fax

Practice location:
  • Phone: 619-537-6910
  • Fax: 619-537-6905
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A18215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: