Healthcare Provider Details

I. General information

NPI: 1164847000
Provider Name (Legal Business Name): LISA LAMBERT RN CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2014
Last Update Date: 03/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

21 TEARDROP
IRVINE CA
92603-0669
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-7101
  • Fax:
Mailing address:
  • Phone: 310-892-9958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number4286555
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: