Healthcare Provider Details

I. General information

NPI: 1710802228
Provider Name (Legal Business Name): LISA RAVALLI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 LANCELOT DR
SACRAMENTO CA
95842-2100
US

IV. Provider business mailing address

5520 LANCELOT DR
SACRAMENTO CA
95842-2100
US

V. Phone/Fax

Practice location:
  • Phone: 916-566-1830
  • Fax:
Mailing address:
  • Phone: 916-566-1830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number250138703
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: