Healthcare Provider Details

I. General information

NPI: 1255338604
Provider Name (Legal Business Name): LISA M DELONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

22 LEGACY WAY
RANCHO SANTA MARGARITA CA
92688-5566
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-5437
  • Fax:
Mailing address:
  • Phone: 937-215-4564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG160625
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: