Healthcare Provider Details

I. General information

NPI: 1083755060
Provider Name (Legal Business Name): LISA D. GARBUTT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2007
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NEWPORT CENTER DR STE 404
NEWPORT BEACH CA
92660
US

IV. Provider business mailing address

400 NEWPORT CENTER DR STE 404
NEWPORT BEACH CA
92660-7687
US

V. Phone/Fax

Practice location:
  • Phone: 949-640-2023
  • Fax: 949-640-7182
Mailing address:
  • Phone: 949-640-2023
  • Fax: 949-640-7182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA90909
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: