Healthcare Provider Details

I. General information

NPI: 1720004088
Provider Name (Legal Business Name): LISA R PONSFORD DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19582 BEACH BLVD STE 180
HUNTINGTON BEACH CA
92648-5978
US

IV. Provider business mailing address

19582 BEACH BLVD STE 180
HUNTINGTON BEACH CA
92648-5978
US

V. Phone/Fax

Practice location:
  • Phone: 714-477-8050
  • Fax:
Mailing address:
  • Phone: 714-477-8050
  • Fax: 714-477-8053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number506021
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12340
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number12340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: