Healthcare Provider Details

I. General information

NPI: 1154652543
Provider Name (Legal Business Name): LISA ODA RN, MSN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 01/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12820 PIONEER BLVD
NORWALK CA
90650-2875
US

IV. Provider business mailing address

1110 N CALERA AVE
COVINA CA
91722-2822
US

V. Phone/Fax

Practice location:
  • Phone: 562-868-0431
  • Fax: 562-868-1297
Mailing address:
  • Phone: 626-915-3303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number563201
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: