Healthcare Provider Details

I. General information

NPI: 1619182656
Provider Name (Legal Business Name): LISA ANN BALDWIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2007
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 AIRPORT PLAZA DR STE 210
LONG BEACH CA
90815-1377
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 562-421-3727
  • Fax: 562-420-8948
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11715
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: