Healthcare Provider Details

I. General information

NPI: 1336408210
Provider Name (Legal Business Name): LISA M WERTHEIM L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 AGATE ST APT A
SAN DIEGO CA
92109-1160
US

IV. Provider business mailing address

9765 CAMINITO CUADRO
SAN DIEGO CA
92129-2821
US

V. Phone/Fax

Practice location:
  • Phone: 970-406-0446
  • Fax:
Mailing address:
  • Phone: 970-406-0446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95039089
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number14853
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: