Healthcare Provider Details

I. General information

NPI: 1457831307
Provider Name (Legal Business Name): LISA MARIE MCCLAIN RCP RRT RRT SDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27300 IRIS AVE RM 2415
MORENO VALLEY CA
92555-4802
US

IV. Provider business mailing address

27300 IRIS AVE RM 2415
MORENO VALLEY CA
92555-4802
US

V. Phone/Fax

Practice location:
  • Phone: 951-251-6209
  • Fax:
Mailing address:
  • Phone: 951-251-6209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRCP10890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: