Healthcare Provider Details

I. General information

NPI: 1699305326
Provider Name (Legal Business Name): LISA OZAETA FNP-C, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 28TH ST STE 200
LONG BEACH CA
90806-2784
US

IV. Provider business mailing address

701 E 28TH ST STE 200
LONG BEACH CA
90806-2784
US

V. Phone/Fax

Practice location:
  • Phone: 562-264-3116
  • Fax:
Mailing address:
  • Phone: 562-264-3116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number652790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: