Healthcare Provider Details

I. General information

NPI: 1477257707
Provider Name (Legal Business Name): LISA CHRISTINE MANN RADT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7885 ANNANDALE AVE OFC
DESERT HOT SPRINGS CA
92240-1419
US

IV. Provider business mailing address

16960 MORSE ST
DESERT HOT SPRINGS CA
92241-1718
US

V. Phone/Fax

Practice location:
  • Phone: 760-329-2924
  • Fax:
Mailing address:
  • Phone: 760-993-8081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberR1484870922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: