Healthcare Provider Details

I. General information

NPI: 1235268251
Provider Name (Legal Business Name): LISA ANNE SWENSSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SCRIPPS DR STE 202
SACRAMENTO CA
95825-6206
US

IV. Provider business mailing address

8240 SUNSET AVE
FAIR OAKS CA
95628-5134
US

V. Phone/Fax

Practice location:
  • Phone: 916-927-1114
  • Fax: 916-927-8721
Mailing address:
  • Phone: 916-965-7720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA82935
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: