Healthcare Provider Details

I. General information

NPI: 1427676048
Provider Name (Legal Business Name): LISA LAROSA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 SAINT HELEN WAY
SALINAS CA
93905-2122
US

IV. Provider business mailing address

830 PARK ROW
SALINAS CA
93901-2406
US

V. Phone/Fax

Practice location:
  • Phone: 904-536-5027
  • Fax:
Mailing address:
  • Phone: 831-754-3635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95177611
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: