Healthcare Provider Details

I. General information

NPI: 1578798609
Provider Name (Legal Business Name): LISA A CRISAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 E ALISAL ST STE 200
SALINAS CA
93905-2516
US

IV. Provider business mailing address

1615 BUNKER HILL WAY SUITE 100
SALINAS CA
93906-6010
US

V. Phone/Fax

Practice location:
  • Phone: 831-769-8807
  • Fax: 831-422-9312
Mailing address:
  • Phone: 831-769-8800
  • Fax: 831-422-9312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number515767
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: