Healthcare Provider Details

I. General information

NPI: 1326282476
Provider Name (Legal Business Name): LISA K PACKARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA K MASTERSON

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 10/29/2026
Certification Date: 10/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2506 SAMARITAN CT
SAN JOSE CA
95124-4001
US

IV. Provider business mailing address

PO BOX 276950
SACRAMENTO CA
95827-6950
US

V. Phone/Fax

Practice location:
  • Phone: 650-934-7555
  • Fax:
Mailing address:
  • Phone: 866-681-0738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA113813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: