Healthcare Provider Details

I. General information

NPI: 1881744423
Provider Name (Legal Business Name): LISA LAW, MD, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 PACIFIC AVE SUITE 302
SAN FRANCISCO CA
94133-4457
US

IV. Provider business mailing address

5320 PACIFIC TERRACE CT
CASTRO VALLEY CA
94552-5539
US

V. Phone/Fax

Practice location:
  • Phone: 415-986-0606
  • Fax:
Mailing address:
  • Phone: 415-986-0606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LISA LAW
Title or Position: SHAREHOLDER
Credential: MD
Phone: 415-986-0606