Healthcare Provider Details

I. General information

NPI: 1982816567
Provider Name (Legal Business Name): LISA-LOUISE RAWAL M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA LOUISE RAWAL M.S.

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 LONG BEACH BLVD STE 700
LONG BEACH CA
90807-2011
US

IV. Provider business mailing address

4300 LONG BEACH BLVD STE 700
LONG BEACH CA
90807-2011
US

V. Phone/Fax

Practice location:
  • Phone: 213-385-5100
  • Fax: 562-256-7126
Mailing address:
  • Phone: 213-385-5100
  • Fax: 562-256-7126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number53176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: