Healthcare Provider Details

I. General information

NPI: 1164229159
Provider Name (Legal Business Name): LISA MARIE HALSEY RCP, CRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 BENTON ST
LOMA LINDA CA
92357-1000
US

IV. Provider business mailing address

11201 BENTON ST
LOMA LINDA CA
92357-1000
US

V. Phone/Fax

Practice location:
  • Phone: 909-583-6298
  • Fax: 909-777-3203
Mailing address:
  • Phone: 909-583-6298
  • Fax: 909-777-3203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278P1004X
TaxonomyPulmonary Diagnostics Certified Respiratory Therapist
License Number20966
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number20966
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: