Healthcare Provider Details

I. General information

NPI: 1003990748
Provider Name (Legal Business Name): LISA L. MAJER D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24411 HEALTH CENTER DR #510
LAGUNA HILLS CA
92653
US

IV. Provider business mailing address

24411 HEALTH CENTER DR #510
LAGUNA HILLS CA
92653
US

V. Phone/Fax

Practice location:
  • Phone: 949-452-7525
  • Fax: 949-452-7511
Mailing address:
  • Phone: 949-452-7525
  • Fax: 949-452-7511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number20A5523
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A5523
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: