Healthcare Provider Details

I. General information

NPI: 1164867339
Provider Name (Legal Business Name): LISA MULLEN SALZ M.S., C.G.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 CAMPUS POINT DR # MC7768
LA JOLLA CA
92037-1300
US

IV. Provider business mailing address

4590 TARANTELLA LN
SAN DIEGO CA
92130-2463
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-7200
  • Fax:
Mailing address:
  • Phone: 858-509-7780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC000209
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: