Healthcare Provider Details

I. General information

NPI: 1578830568
Provider Name (Legal Business Name): ELIZABETH V SISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2011
Last Update Date: 11/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 LA MESA BLVD
LA MESA CA
91942-0217
US

IV. Provider business mailing address

2155 CORTE VISTA APT#108
CHULA VISTA CA
91915
US

V. Phone/Fax

Practice location:
  • Phone: 619-466-3246
  • Fax:
Mailing address:
  • Phone: 619-946-7870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number12000090
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: